Tacrolimus in the long-term immunosuppressive treatment of the renal transplant recipients — practical advices

Abstract

Tacrolimus got the position crucial immunosuppressive drug in a solid organ transplantation. For obtaining the best long-term results it is essential an avoidance of excessive dose lowering and maintenance stable drug concentration. The intrapatient tacrolimus concentration variability, which exerts negative impact on the graft survival, should be differentiated from fluctuation, describing distinct pharmacokinetic event, without proven clinical significance. Furthermore, real tacrolimus concentration variability should be separated from variability caused by recipient instability. Among causes of tacrolimus intrapatient variability on the first places are: insufficient adherence to treatment and drugs interactions.