| Autor: |
Job KM; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Roberts JK; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Enioutina EY; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Illamola SM; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA., Kumar SS; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Rashid J; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Ward RM; Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.; Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA., Fukuda T; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Sherbotie J; Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA., Sherwin CM; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.; Department of Pediatrics, Boonshoft School of Medicine, Dayton Children's Hospital, Wright State University, Dayton, OH, USA.; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. |
| Abstrakt: |
Introduction: Graft survival in pediatric kidney transplant patients has increased significantly within the last three decades, correlating with the discovery and utilization of new immunosuppressants as well as improvements in patient care. Despite these developments in graft survival for patients, there is still improvement needed, particularly in long-term care in pediatric patients receiving grafts from deceased donor patients. Maintenance immunosuppressive therapies have narrow therapeutic indices and are associated with high inter-individual and intra-individual variability. Areas covered: In this review, we examine the impact of pharmacokinetic variability on renal transplantation and its association with age, genetic polymorphisms, drug-drug interactions, drug-disease interactions, renal insufficiency, route of administration, and branded versus generic drug formulation. Pharmacodynamics are outlined in terms of the mechanism of action for each immunosuppressant, potential adverse effects, and the utility of pharmacodynamic biomarkers. Expert opinion: Acquiring abetter quantitative understanding of immunosuppressant pharmacokinetics and pharmacodynamic components should help clinicians implement treatment regimens to maintain the balance between therapeutic efficacy and drug-related toxicity. |
