Alghanem Sarah S, Soliman Moetaza M, Alibrahim Ali A, Gheith Osama, Kenawy Ahmed S, Awad Abdelmoneim
Department of Pharmacy Practice, Kuwait University, Kuwait City, Kuwait.
Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt.
Front Pharmacol. 2020 Nov 20;11:566638. doi: 10.3389/fphar.2020.566638. eCollection 2020.
There is a lack of data in the literature on the evaluation of tacrolimus (TAC) dosage regimen and monitoring after kidney transplantation (KT) in Kuwait. The aim of the present study was to evaluate TAC dosing in relation to the hospital protocol, the achievement of target TAC trough concentration (C), the prevalence of TAC side effects (SEs), namely, posttransplant diabetes mellitus (PTDM), denovo hypertension (HTN), and dyslipidemia, and factors associated with the occurrence of these SEs among KT recipients. A retrospective study was conducted among 298 KT recipients receiving TAC during the first year of PT. Descriptive and multivariate logistic regression analyses were used. The initial TAC dosing as per the local hospital protocol was prescribed for 28.2% of patients. The proportion of patients who had C levels within the target range increased from 31.5 to 60.3% during week 1 through week 52. Among patients who did not have HTN, DM, or dyslipidemia before using TAC, 78.6, 35.2, and 51.9% of them were prescribed antihypertensive, antidiabetic, and antilipidemic medications during the follow-up period. Age of ≥40 years was significantly associated with the development of HTN, dyslipidemia, and PTDM ( < 0.05). High TAC trough concentration/daily dose (C/D) ratio was significantly associated with the development of PTDM ( < 0.05). Less than two-fifths of patients achieved target TAC C levels during the first month of PT. Side effects were more common in older patients. These findings warrant efforts to implement targeted multifaceted interventions to improve TAC prescribing and monitoring after KT.
科威特关于肾移植（KT）后他克莫司（TAC）给药方案评估及监测的文献资料匮乏。本研究的目的是评估TAC给药与医院方案的相关性、目标TAC谷浓度（C）的达成情况、TAC副作用（SEs）的发生率，即移植后糖尿病（PTDM）、新发高血压（HTN）和血脂异常，以及KT受者中这些SEs发生的相关因素。对298例在移植后第一年接受TAC治疗的KT受者进行了一项回顾性研究。采用描述性和多变量逻辑回归分析。根据当地医院方案进行初始TAC给药的患者占28.2%。在第1周和第52周期间，C水平在目标范围内的患者比例从31.5%增加到60.3%。在使用TAC前没有HTN、DM或血脂异常的患者中，78.6%、35.2%和51.9%的患者在随访期间接受了抗高血压、抗糖尿病和抗血脂药物治疗。年龄≥40岁与HTN、血脂异常和PTDM的发生显著相关（<0.05）。高TAC谷浓度/每日剂量（C/D）比与PTDM的发生显著相关（<0.05）。在移植后第一个月，不到五分之二的患者达到了目标TAC C水平。副作用在老年患者中更常见。这些发现值得努力实施有针对性的多方面干预措施，以改善KT后TAC的处方和监测。
