Case Report: Low Hematocrit Leading to Tacrolimus Toxicity

Autor: Alexandre Piletta-Zanin, Aurélie De Mul, Nathalie Rock, Pierre Lescuyer, Caroline F. Samer, Frédérique Rodieux
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Frontiers in Pharmacology, Vol 12 (2021)
Druh dokumentu: article
ISSN: 1663-9812
DOI: 10.3389/fphar.2021.717148
Popis: Tacrolimus is a calcineurin inhibitor characterized by a narrow therapeutic index and high intra- and inter-individual pharmacokinetic variability. Therapeutic drug monitoring in whole-blood is the standard monitoring procedure. However, tacrolimus extensively binds to erythrocytes, and tacrolimus whole-blood distribution and whole-blood trough concentrations are strongly affected by hematocrit. High whole-blood tacrolimus concentrations at low hematocrit may result in high unbound plasma concentrations and increased toxicity. We present the case of a 16-year-old girl with kidney and liver transplant in whom low concentrations of tacrolimus in the context of low hematocrit led to significant increase in the dosage of tacrolimus and participate, along with a genetic polymorphism of ABCB1, in nephrotoxicity.
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