Effects of CYP3A5 gene polymorphism and Wuzhi capsule on early postoperative tacrolimus exposure and adverse reactions in renal transplant patients
OBJECTIVE To investigate the effects of CYP3A5 gene polymorphism and Wuzhi capsule(WZ)on early postoperative tacrolimus exposure and adverse reactions in renal transplant patients.METHODS A total of 132 patients who underwent renal transplantation and received tacrolimus+mycophenolic acids+prednisone after operation in our hospital from September 2021 to September 2023 were selected and divided into four groups according to genotypes(CYP3A5*1 or CYP3A5*3/*3)and with or without WZ("+WZ"meant drug combination,"+NO WZ"meant without combination).The blood trough concentration/daily dose(c0/D)values of the four groups were analyzed on the 14th day,1 month and 3 months after renal transplantation.The incidence of acute rejection and the incidence of tacrolimus-related adverse reactions within 3 months after transplantation were compared among 4 groups.RESULTS On the 14th day,1 month and 3 months after surgery(except for the CYP3A5*1+WZ group),c0/D values of CYP3A5*1 genotype patients were significantly lower than those of CYP3A5*3/*3 genotype patients regardless of whether they were treated with WZ additionally(P＜0.05).Within 3 months after surgery,although there was no significant difference in the incidence of acute rejection and tacrolimus-related adverse reactions among the four groups(P＞0.05),the incidence of hyperglycemia in patients with CYP3A5*3/*3 was higher(41.67%).CONCLUSIONS CYP3A5 gene polymorphism is significantly related to tacrolimus c0/D in kidney transplant patients.Under the premise of c0 monitoring of tacrolimus,patients with CYP3A5*1 genotype should be given WZ as soon as possible after surgery to accelerate tacrolimus to reach the therapeutic concentration range,while CYP3A5*3/*3 genotype is not recommended to be given WZ because of the higher risk of hyperglycemia.
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