engleski

Therapeutic drug monitoring in transplant patients

Background. Immunosuppressive drugs in transplant patients represent life -long therapy and are the key to prevention of acute and chronic graft rejection. The specific pharmacokinetic profile of each immunosuppressive drug, low therapeutic index and potential interactions with numerous medications indicate the fact that monitoring of immunosuppressive therapy is the essential part of therapy protocol in transplant patients. Materials and Methods. Since 1998, when the first liver transplantation was performed, the total number of patients that underwent liver transplantation reached 363, 182 patients underwent kidney transplantation and there were 2 transplantations of small intestine. For determination of immunosuppressive tacrolimus, cyclosporine and sirolimus CMIA (Chemiluminescent Magnetic Microparticle Immunoassay) method was applied, everolimus was determined applying FPIA (Fluorescence polarization immunoassay), mycophenolate was determined by EMIT (enzyme multiplied immunoassay technique) method and all routine biochemical tests were performed on Olympus AU 600 analyzer using standard laboratory methods. Results. The overall one-year survival rate for patients who underwent solid organ transplantation in University Hospital Merkur, Zagreb, Croatia is above 85%. In immunosuppressive protocols calcineurin inhibitors (cyclosporine, tacrolimus) dominate in applications and they are most frequently used in combination with mycophenolate mophetil, sirolimus, everolimus, corticosteroids. The routine laboratory tests cannot discriminate changes arisen due acute graft rejection or graft dysfunction of some other etiology neither can they determine the grade of rejection. Conclusions. Monitoring of immunosuppressive drugs represents a multidisciplinary challenge for clinicians and laboratory specialists.

therapeutic drug monitoring; transplantation

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