Department of Laboratory Diagnostics, Division of Pharmacogenomics & Therapy Individualization, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Nephrology, University Hospital Merkur, Internal Clinic, Zagreb, Croatia.
J Clin Pharm Ther. 2022 Sep;47(9):1461-1465. doi: 10.1111/jcpt.13650. Epub 2022 Mar 27.
Tacrolimus (TAC) is an immunosuppressant with large interpatient pharmacokinetic variability and a narrow therapeutic index. We report a case of acute cellular rejection (ACR) type IB with insufficient TAC blood concentrations (TAC C ).
ACR developed on the eighth postoperative day of kidney transplantation. During this period, TAC C were insufficient. This referred pharmacogenetic assessment disclosed the patient as a CYP3A5 expresser and CYP3A4*1B carrier. According to the genotype, higher doses of TAC, 15 mg twice daily, were administered and targeted TAC C were achieved.
Our case presents an association of TAC rapid clearance and two alleles modifying greater CYP3A enzyme activity.
他克莫司（TAC）是一种免疫抑制剂，具有较大的个体间药代动力学变异性和狭窄的治疗指数。我们报告了一例他克莫司血药浓度（TAC C ）不足的急性细胞排斥反应（ACR）IB 型病例。
肾移植术后第 8 天发生 ACR。在此期间，TAC C 不足。该药物遗传学评估显示患者为 CYP3A5 表达者和 CYP3A4*1B 携带者。根据基因型，给予更高剂量的他克莫司，每日两次 15mg，并达到目标 TAC C 。
我们的病例提示 TAC 快速清除与两种等位基因修饰 CYP3A 酶活性增加有关。
