Imunosupresantų – ciklosporino, takrolimuzo ir mikofenolato mofetilio koncentracijų sklaida pacientų kraujyje po inkstų transplantacijos

Objective and tasks The main objective of this study is to evaluate the dispersion of immunosuppressive drugs cyclosporine (CsA), tacrolimus (Tacro) and mycophenolate mofetil (MMF) concentrations in patients’ plasma for patients after kidney transplantation. Our tasks were 1) to identify therapeutic window for cyclosporine receiving patients; 2) to evaluate dispersion of these drugs concentrations in patients’ plasma after kidney transplantation and to examine estimated and reference therapeutic windows fitting; 3) to compare obtained monitoring results between monotherapy and two immunosuppressive drugs therapy; 4) and to evaluate do the time after kidney transplantation and patients’ age affect the therapeutic window fitting. Methods. Drug (immunosuppressant) exposure level was based on calculation of the mean area under the concentration – time curve AUC (0-12). The AUC (0-12) was estimated using a Bayesian estimator and three – point limited sampling strategy. Evaluations of obtained results were processed by using “IBM SPSS Statistics 20”. Study population. 427 patients, 20 – 84 years of age, renal transplant recipients who underwent 817 times immunosuppressants (cyclosporine, tacrolimus and MMF) monitoring in the university hospital of Limoges during 2011. Results. Obtained therapeutic window fitting in monotherapy case was 5 pts (55.6%) receiving MMF, 8 pts (34.8%) receiving tacrolimus and 18 pts (36.7%) receiving cyclosporine. In two immunosuppressive drugs treatment the most accurate therapeutic window fitting was in 86 pts (64.2%) receiving MMF and CsA, and in 83 pts (70.3%) receiving MMF and Tacro, the lowest accuracy was in 25 pts (18.9%) receiving CsA and MMF. Patients’ age and post-transplantation time do not affect the dispersion of tested drugs, in all cases chi square (χ2) p- value were > α = 0.05. Conclusion. According to the obtained results we can confirm that cyclosporine, tacrolimus and MMF monitoring is required for the treatment to be effective, since only a small parts of patients AUC exposures are within the therapeutic window