Kocur Arkadiusz, Pawiński Tomasz
Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland.
Bioanalysis. 2025 Mar;17(6):413-427. doi: 10.1080/17576180.2025.2477976. Epub 2025 Mar 28.
Immunosuppressive pharmacotherapy after solid organ transplantation (SOT) requires therapeutic drug monitoring (TDM) for therapy individualization. The venous whole blood is still considered as routine matrix for monitoring immunosuppressive drug concentration. On the other hand, as an alternative, capillary blood collected using noninvasive sampling is convergent with a patient-centric approach. Despite their disadvantages regarding sample homogeneity and the hematocrit effect, well-known dried blood spot techniques have shown promising results. Volumetric absorptive microsampling (VAMS) and quantitative dried blood spot (qDBS) have successfully eliminated these unfavorable biased elements. Microsampling can be used in transplant recipients' care, mainly due to long-term therapy under control drug concentrations and the long distance between the place of the patient's residence and the diagnostic laboratory in the transplant center. The study aimed to discuss the clinical consequences of implementing microsampling techniques for TDM of immunosuppressants. Additionally, we have discussed the 'hot topics' in microsampling: home-based self-sampling, adherence to therapy monitoring, and drug concentration conversion to estimated traditional matrices. Finally, based on our experience and current practice, we propose best practices for microsampling implementation from bench to bedside. Microsampling techniques can potentially revolutionise immunosuppressive pharmacotherapy by enabling patient-centric individualisation in various subpopulations, significantly improving post-transplant care.
实体器官移植（SOT）后的免疫抑制药物治疗需要进行治疗药物监测（TDM）以实现个体化治疗。静脉全血仍被视为监测免疫抑制药物浓度的常规样本基质。另一方面，作为一种替代方法，使用非侵入性采样采集的毛细血管血符合以患者为中心的方法。尽管传统的干血斑技术在样本均一性和血细胞比容效应方面存在缺点，但已显示出有前景的结果。体积吸收微量采样（VAMS）和定量干血斑（qDBS）已成功消除了这些不利的偏差因素。微量采样可用于移植受者的护理，主要是因为需要在药物浓度控制下进行长期治疗，且患者居住地与移植中心诊断实验室之间距离较远。该研究旨在探讨实施微量采样技术用于免疫抑制剂TDM的临床后果。此外，我们还讨论了微量采样中的“热门话题”：居家自我采样、治疗监测的依从性以及将药物浓度转换为估计的传统样本基质。最后，基于我们的经验和当前实践，我们提出了从实验室到床边实施微量采样的最佳实践方法。微量采样技术有可能通过在各个亚群体中实现以患者为中心的个体化，显著改善移植后护理，从而彻底改变免疫抑制药物治疗。
