A retrospective study of tacrolimus trough level changes in renal transplant recipients with diarrhea
OBJECTIVE To explore the changes of tacrolimus trough levels in renal transplant(RT)recipients with diarrhea and provide rationales for the dosing safety of medication.METHODS From January 2013 to May 2023,retrospective survey was conducted for 18 RT patients with diarrhea.Further analysis was performed to compare the changes in tacrolimus trough lev-els,administered doses and related parameters before,during and after diarrhea.RESULTS There were 13 males and 5 females with an age range of(21-66)year.Median transplantation time was 36.0(11.5,44.0)month.Both tacrolimus blood trough con-centration and blood trough concentration/administered dose spiked markedly during diarrhea(P＜0.05).Tacrolimus blood trough concentration exceeded 15 ng·mL-1(n=5).For patient safety,dose adjustment was performed based upon therapeutic drug monitoring with a reduction of 0.5～2 mg·d-1(n=11).No significant differences existed in heptorenal function parameters,serum albumin and hematocrit before and after diarrhea(P＞0.05).Transient elevation of serum creatinine occurred during diar-rhea(n=9),including a transient elevation of alanine transaminase and aspartate transaminase(n=1)and a transient increase in aspartate transaminase(n=1).All abnormal parameters nromalized after diarrhea.CONCLUSION Close therapeutic drug moni-toring and early tacrolimus dose adjustment are strongly recommended for RT patients with diarrhea to ensure medication safety.
renal transplanttacrolimusdiarrheatherapeutic drug monitoring
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