The department of pharmacy, Croix-Rousse hospital, hospices civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
Clin Res Hepatol Gastroenterol. 2012 Dec;36(6):e126-30. doi: 10.1016/j.clinre.2012.05.011. Epub 2012 Jun 29.
Although the feasibility of oral tacrolimus administration in the presence of jejunostomy has already been reported, few studies monitoring tacrolimus trough blood levels have been analyzed in detail, either during or after a jejunostomy closure. We report on our experience with a 34-year-old patient who underwent liver transplantations, with a proximal jejunostomy constructed a few days prior to the second transplantation. He was administered tacrolimus by a predominantly oral route, and less frequently received it by jejunostomy. The aim of this paper is to discuss this administration strategy and whether a different method could have been more suitable. This case report highlights that during the jejunostomy period, the tacrolimus doses that were required to maintain trough concentrations within the therapeutic range were four times higher than those administered after the closure of the jejunostomy. We observed an increase in the Dose-Normalized Trough Concentration (DNTC) values when tacrolimus was administered for 4 consecutive days by jejunostomy as compared to oral administration, indicating that the relative bioavailability of tacrolimus increased. Moreover, when returning to oral administration, the subsequent DNTC value was halved, highlighting a reduction in the tacrolimus bioavailability. Thus, in such a case, administration by jejunostomy could be more appropriate.
虽然已有文献报道肠内给予他克莫司在存在空肠造口的情况下具有可行性，但很少有研究详细分析在空肠造口关闭期间或之后监测他克莫司谷浓度。我们报告了一位 34 岁患者的经验，该患者在第二次移植前几天接受了肝移植，并建立了近端空肠造口。他主要通过口服途径给予他克莫司，偶尔也通过空肠造口给予。本文的目的是讨论这种给药策略，以及是否可以采用其他方法更为合适。本病例报告强调，在空肠造口期间，为维持谷浓度在治疗范围内所需的他克莫司剂量比空肠造口关闭后给予的剂量高四倍。我们观察到，与口服相比，连续 4 天通过空肠造口给予他克莫司时，剂量标准化谷浓度（DNTC）值增加，表明他克莫司的相对生物利用度增加。此外，当恢复口服给药时，随后的 DNTC 值减半，表明他克莫司的生物利用度降低。因此，在这种情况下，通过空肠造口给药可能更为合适。
