Kidney transplant patients

The data in kidney transplant patients indicate that the black patients required a higher dose to attain comparable trough concentrations compared with Caucasian patients. 

Insulin-dependent posttransplant diabetes mellitus (PTDMj. lnsulin-dependent PTDM was reported in 20% of tacrolimus-treated kidney patients without pretransplant history of diabetes mellitus in the Phase 3 study. The median time to onset of PTDM was 68 days. Insulin dependence was reversible in 15% of these PTDM patients at 1 year and in 50% at 2 years posttransplant. Black and Hispanic kidney transplant patients were at an increased risk of development of PTDM. 

Nephrotoxicity Tacrolimus can cause nephrotoxicity, particularly when used in high doses. Nephrotoxicity has been noted in approximately 52% of kidney transplantation patients and in 33% to 40% of liver transplantation patients receiving the drug. 

It is recently approved for immunosuppression in liver and kidney transplant patients. 

Anaphylactic and serum sickness reactions to ALG and murine monoclonal antibodies have been observed and usually require cessation of therapy. Complexes of host antibodies with horse ALG may precipitate and localize in the glomeruli of the kidneys. Even more disturbing has been the development of histiocytic lymphomas in the buttock at the site of ALG injection. The incidence of lymphoma as well as other forms of cancer is increased in kidney transplant patients. It appears likely that part of the increased risk of cancer is related to the suppression of a normally potent defense system against oncogenic viruses or transformed cells. The preponderance of lymphoma in these cancer cases is thought to be related to the concurrence of chronic immune suppression with chronic low-level lymphocyte proliferation. 

Better compliance than with nystatin. Currently, the drug of choice for prophylaxis. A recent report suggested that clotrimazole troche can increase tacrolimus blood levels. (Vasquez E, Poliak R, Benedetti E. Clotrimazole increases tacrolimus blood levels a drug interaction in kidney transplant patients. Clin Transplant. 2001 15(2) 95-9.)... 

Sirolimus is rapidly absorbed after it is given orally, and in healthy individuals, peak blood levels are achieved about an hour after oral administration. However, it takes twice as long to reach peak blood levels in kidney transplant patients. Its systemic availability is about 15% and high-fat meals interfere with the bioavailability. Sirolimus is bound (40%) to proteins in plasma, and its elimination half-life is about 12-15 h for transplant patients, but may vary. It is predominantly metabolized by CYP2A4 the drug has a number of active metabolites and is excreted in feces. 

Bermond B, Surachno S, Lok A, ten Berge IJ, Plasmans B, Kox C, Schuller E, Schellekens PT, Hamel R. Memory functions in prednisone-treated kidney transplant patients, din Transplant 2005 19(4) 512-7. 

Talalaj M, Gradowska L, Marcinowska-Suchowierska E, Durlik M, Gaciong Z, Lao M. Efficiency of preventive treatment of glucocorticoid-induced osteoporosis with 25-hydroxyvitamin D3 and calcium in kidney transplant patients. Transplant Proc 1996 28(6) 3485-7. 

Safety and Tolerability Study of Inhaled Carbon Monoxide in Kidney Transplant Patients http //www.clinicaltrials.gov/ct2/show/NCT00531856. Accessed 16 Feb 2010... 

Azoulay D, Castaing D, Lemoine A, Samuel D, Majno P, Reynes M, Charpentier B, Bismuth H. Successful treatment of severe azathioprine-induced hepatic veno-occlu-sive disease in a kidney-transplanted patient with transjugular intrahepatic portosystemic shunt. Clin Nephrol 1998 50(2) 118-22. 

A reciprocal interaction between ciclosporin and saquinavir has been reported in an HIV-positive kidney transplant patient (293). Whereas ciclosporin concentrations were previously acceptable, there was a three-fold increase in ciclosporin trough concentrations after 3 days of saquinavir (3600 mg/day). In addition, the saquinavir AUC was four times higher than that usually observed in patients taking similar dosages. 

Shield CF III, McGrath MM, Goss TF. Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus (FK506)-based versus cyclosporine-based immunosuppression. FK506 Kidney Transplant Study Group. Transplantation 1997 64(12) 1738-43. 

Lee MO, Park SK, Choi JH, Sung KJ, Moon KC, Koh JK. Juxta-clavicular beaded lines in a kidney transplant patient receiving immunosuppressants. J Dermatol 2002 29(4) 235-7. 

Wynckel A, Toupance O, Melin JP, David C, Lavaud S, Wong T, Lamiable D, Chanard J. Traitement des legionelloses par ofloxacine chez le transplante renal. Absence d interference avec la ciclosporine A. [Treatment of legionellosis with ofloxacin in kidney transplanted patients. Lack of interaction with cyclosporin A.] Presse Med 1991 20(7) 291-3. 

Outeda Macias M, Salvador P, Hurtado JL, Martin I. TacroUmus-itraconazole interaction in a kidney transplant patient. Ann Pharmacother 2000 34(4) 536. 

Pooled data from the tricontinental and the US studies in kidney transplant patients showed incidences of diarrhea of 31 and 36% in patients taking 2 and 3 g/day respectively (11). In a retrospective study, 29% of 109 mycophenolate-treated patients had diarrhea that required hospitalization and 12% developed upper intestinal symptoms (gastritis, esophagitis) (12). Frequent dosage reduction was necessary and only 28% of patients were still taking full doses after 1 year. 

Villaverde V, Cantalejo M, Balsa A, Mola EM, Sanz A. Leg bone pain syndrome in a kidney transplant patient treated with tacrolimus (FK506). Ann Rheum Dis 1999 58(10) 653-4. 

Buchler M, Leibenguth P, Le Guellec C, Carayon A,Watier H, Odoul F, Autret-Lec, E, Lebranchu Y, and Paintaud G. 2004. Relationship between calcineurin inhibition and plasma endothelin concentrations in cyclosporine-A-treated kidney transplant patients. EurJClin Pharmacol 60 703-708. 

Rostaing L, Modesto A, Baron E,Cisterne J,Chabannier M,and Durand D. Acute renal failure in kidney transplant patients treated with interferon alpha 2b for chronic hepatitis C. Nephron 74 512-516,1996. 

Berg KJ, Nordby G, Rootwelt K, Djoseland O, Eauchald P, Mehl A, et al. Effects on renal function of combined treatment with trimethoprim and cyclosporine A in kidney transplant patients. Transplantation proceedings. 1988 Jun 20(3) 413-5. 

Cidofovir is an acyclic nucleotide analogue of the monophosphate of cytosine. When phosphoiylated by host cellular enzymes, the active compound cidofovir diphosphate has broad activity against the herpes viruses, including CMV, HSV 1 and 2, VZV, Epstein-Barr virus, and the BK polyomavirus. Cidofovir has primarily been used in the treatment of CMV retinitis in patients who have failed treatment with ganciclovir or foscarnet and in acyclovir-resistant herpes simplex infections. More recently, there is also a growing experience with the use of this medication in kidney transplant patients who have BK virus-associated nephropathy [31], although this interest has been dampened by significant toxicity and only modest clinical activity [32]... 

Trofe J, Hirsch HH, Ramos E. Polyomavirus-associated nephropathy update of clinical management in kidney transplant patients. TranspI Infect Dis 2006 8 76-85. 

Lorf T, Ramadori G, Ringe B, Schworer H. Pantoprazole does not affect cyclosporin A blood concentration in kidney-transplant patients. Eur J Clin Pharmacol 2000 55(10) 733-5. 

Hansen JM, Hoy CE, Strandgaard S. Eish oil and cyclosporin A-induced renal hypoperfusion in kidney- transplanted patients. Nephrol Dial Transplant 1995 10 1745-1750. 

Garcia TM, da Costa JA, Costa RS, Ferraz AS. Acute tubular necrosis in kidney transplant patients treated with enalapril. Ren Fail 1994 16 419-423. 

Pollard SG, Lear PA, Ready AR, Moore RFI, Johnson RW. Comparison of microemulslon and conventional formulations of cyclosporine Ain preventing acute rejection in de novo kidney transplant patients.The U.K. Neoral Renal Study Group.Transplantation 1999 68 1325-1331. 

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