Interpreting tacrolimus concentrations during pregnancy and postpartum.

Abstract:

:Pregnancy after solid organ transplantation, although considered high risk for maternal, fetal, and neonatal complications, has been quite successful. Tacrolimus pharmacokinetic changes during pregnancy make interpretation of whole blood trough concentrations particularly challenging. There are multiple factors that can increase the fraction of unbound tacrolimus, including but not limited to low albumin concentration and low red blood cell count. The clinical titration of dosage to maintain whole blood tacrolimus trough concentrations in the usual therapeutic range can lead to elevated unbound concentrations and possibly toxicity in pregnant women with anemia and hypoalbuminemia. Measurement of plasma or unbound tacrolimus concentrations for pregnant women might better reflect the active form of the drug, although these are technically challenging and often unavailable in usual clinical practice. Tacrolimus crosses the placenta with in utero exposure being approximately 71% of maternal blood concentrations. The lower fetal blood concentrations are likely due to active efflux transport of tacrolimus from the fetus toward the mother by placental P-glycoprotein. To date, tacrolimus has not been linked to congenital malformations but can cause reversible nephrotoxicity and hyperkalemia in the newborn. In contrast, very small amounts of tacrolimus are excreted in the breast milk and are unlikely to elicit adverse effects in the nursing infant.

journal_name

Transplantation

journal_title

Transplantation

authors

Hebert MF,Zheng S,Hays K,Shen DD,Davis CL,Umans JG,Miodovnik M,Thummel KE,Easterling TR

doi

10.1097/TP.0b013e318278d367

subject

Has Abstract

pub_date

2013-04-15 00:00:00

pages

908-15

issue

7

eissn

0041-1337

issn

1534-6080

journal_volume

95

pub_type

杂志文章,评审
  • De novo sirolimus-based immunosuppression after liver transplantation for hepatocellular carcinoma: long-term outcomes and side effects.

    abstract:BACKGROUND:We report long-term outcomes and side effects after transplantation for hepatocellular carcinoma (HCC) using de novo, sirolimus-based immunosuppression (IS). METHODS:A total of 70 patients with HCC (mean age: 54.4+/-7 years, female/male: 12/58) were transplanted and included in the study. Immunosuppression ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000262607.95372.e0

    authors: Toso C,Meeberg GA,Bigam DL,Oberholzer J,Shapiro AM,Gutfreund K,Ma MM,Mason AL,Wong WW,Bain VG,Kneteman NM

    更新日期:2007-05-15 00:00:00

  • Vascular endothelial growth factor c/vascular endothelial growth factor receptor 3 signaling regulates chemokine gradients and lymphocyte migration from tissues to lymphatics.

    abstract:BACKGROUND:Circulation of leukocytes via blood, tissue and lymph is integral to adaptive immunity. Afferent lymphatics form CCL21 gradients to guide dendritic cells and T cells to lymphatics and then to draining lymph nodes (dLN). Vascular endothelial growth factor C and vascular endothelial growth factor receptor 3 (V...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0000000000000561

    authors: Iwami D,Brinkman CC,Bromberg JS

    更新日期:2015-04-01 00:00:00

  • Serial transplantation resulting in tolerance to an unrelated cord blood graft.

    abstract::Unrelated cord blood (UCB) hematopoietic stem cells were serially transplanted into two human leukocyte antigen (HLA)-identical siblings with T cell, B cell, natural killer cell severe combined immunodeficiency. Brother A received a 4/6-matched, HLA DRbeta1-identical but class I-disparate UCB graft after myeloablative...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000209659.59606.f2

    authors: Goebel WS,Nelson RP Jr,Brahmi Z,Gowan DJ,Towell PJ,Robertson KA,Haut PR

    更新日期:2006-06-15 00:00:00

  • A pilot study of immunosuppressive monotherapy in liver transplantation: tacrolimus versus microemulsified cyclosporin.

    abstract:BACKGROUND:Many reports of successful early withdrawal of regular maintenance steroids in transplant recipients have appeared in recent years. The question now arises whether, in the current age of powerful nonsteroidal immunosuppressants such as Neoral and Tacrolimus, routine administration of steroids posttransplant ...

    journal_title:Transplantation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00007890-199910270-00021

    authors: Rolles K,Davidson BR,Burroughs AK

    更新日期:1999-10-27 00:00:00

  • Factors influencing early renal function in cadaver kidney transplants. A case-control study.

    abstract::We performed a multicenter study to investigate the problem of cadaver kidney transplants that never achieve function, or that recover after a period of delayed function, and we used multivariate techniques to model the results. Sixty-nine patients who received cadaver kidney transplants that never functioned (NF) wer...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198801000-00027

    authors: Halloran P,Aprile M

    更新日期:1988-01-01 00:00:00

  • Long-term follow-up of recipients of combined human leukocyte antigen-matched bone marrow and kidney transplantation for multiple myeloma with end-stage renal disease.

    abstract:BACKGROUND:Specific tolerance after combined kidney and bone marrow transplantation for multiple myeloma with end-stage renal disease through mixed lymphohematopoietic chimerism has been achieved, as evidenced by prolonged normal renal function without ongoing immunosuppression. METHODS:To achieve potent antimyeloma r...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31820a3068

    authors: Spitzer TR,Sykes M,Tolkoff-Rubin N,Kawai T,McAfee SL,Dey BR,Ballen K,Delmonico F,Saidman S,Sachs DH,Cosimi AB

    更新日期:2011-03-27 00:00:00

  • Local cellular immunity in the draining lymph nodes of mice after immunization with histocompatibility alloantigens.

    abstract::Mice immunized with allogeneic cells exhibit a local component of cellular immunity that is confined to lymph nodes draining the site of immunization. After immunization of C3H mice by skin grafting or by i.p. or footpad injection of F1 hybrid spleen cells, draining lymph nodes show increased responsiveness toward the...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198107000-00006

    authors: Snow C,Hilgard HR

    更新日期:1981-07-01 00:00:00

  • Computer-assisted quantification of fibrosis in chronic allograft nephropaty by picosirius red-staining: a new tool for predicting long-term graft function.

    abstract:BACKGROUND:Chronic allograft nephropathy (CAN) has become the predominant limiting factor for long-term transplant survival. A cardinal histomorphologic correlate for CAN is interstitial fibrosis. Currently, no method has been established in routine use that reliably quantifies the extent of interstitial fibrosis in re...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.TP.0000078899.62040.E5

    authors: Pape L,Henne T,Offner G,Strehlau J,Ehrich JH,Mengel M,Grimm PC

    更新日期:2003-09-27 00:00:00

  • High incidence of monoclonal immunoglobulins in patients after liver or heart transplantation.

    abstract::Sera from 56 recipients of liver or heart transplants were investigated for monoclonal immunoglobulins (mIg) by immunofixation electrophoresis (IFE) at different times during 4 years after transplantation. Transient, changing, or stable mIgs were found in 18 patients. A significantly increased mIg incidence was observ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198809000-00011

    authors: Peest D,Schaper B,Nashan B,Wonigeit K,Raude E,Pichlmayr R,Haverich A,Deicher H

    更新日期:1988-09-01 00:00:00

  • Escaping from rejection.

    abstract::Since the earliest days of transplantation, immunobiologists have sought means to prevent recognition and rejection of foreign tissue. The goal of these strategies is the retention of recipient immune function while selectively avoiding graft injury. Although considerable theoretical and technical problems remain, an ...

    journal_title:Transplantation

    pub_type: 杂志文章,评审

    doi:10.1097/TP.0b013e3181bcc93a

    authors: Lynch RJ,Platt JL

    更新日期:2009-12-15 00:00:00

  • Heart rate after cardiac transplantation-lessons from the tortoise and the shrew.

    abstract::There is a striking consistency in the total number of heart beats accrued over a lifetime across a range of animal species despite vast differences in size. Moreover, an inverse relationship is observed between heart rate and lifespan, leading to speculation that elevated heart rate could significantly affect longevi...

    journal_title:Transplantation

    pub_type: 社论,评审

    doi:10.1097/TP.0b013e31826bc42a

    authors: Critchley WR,Yonan N,Shaw SM,Fildes JE

    更新日期:2013-01-27 00:00:00

  • Racial disparities in living kidney donation: is there a lack of willing donors or an excess of medically unsuitable candidates?

    abstract:BACKGROUND:Live kidney donation is safe for healthy donors and an effective treatment for patients with end-stage renal disease. Many potential donors are referred for live kidney donation, but only a small percentage donate. This study aims to determine reasons for nondonation and establish if racial differences exist...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000232693.69773.42

    authors: Lunsford SL,Simpson KS,Chavin KD,Menching KJ,Miles LG,Shilling LM,Smalls GR,Baliga PK

    更新日期:2006-10-15 00:00:00

  • Ontogeny of suppressor cells. II. Suppression of graft-versus-host and mixed leukocyte culture responses by embryonic cells.

    abstract::Ontogenic development of suppressor cells was studied in mouse embryos. It was found that liver cells of embryos at various stages of gestation were capable of interfering with the mixed leukocyte culture (MLC) reaction. The MLC reaction was also inhibited by embryonic spleen and thymus cells. However, the latter were...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-197812000-00016

    authors: Globerson A,Umiel T

    更新日期:1978-12-01 00:00:00

  • Alterations in chemokine receptor CCR5 expression on blood dendritic cells correlate with acute graft-versus-host disease.

    abstract:BACKGROUND:Dendritic cells (DC) are important in the development of acute graft-versus-host disease (GVHD) after allogeneic hemopoietic cell transplantation (alloHCT). The trafficking of immature DC from blood to GVHD target organs is likely to be regulated by chemokine receptors. METHODS:We performed flow cytometry t...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e31829e6d5b

    authors: Shahin K,Sartor M,Hart DN,Bradstock KF

    更新日期:2013-10-27 00:00:00

  • The results of reduced-size liver transplantation, including split livers, in patients with end-stage liver disease.

    abstract::We initiated a policy of using RSLT in critically ill patients in June of 1988. Since that time we have performed 30 RSLTs in 29 patients, including 28 children and 1 adult. The mean age of the children was 27 months (range 1 month to 10 years) with 14 (52%) being 1 year of age or less. The mean weight was 11.3 kg (ra...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199202010-00023

    authors: Langnas AN,Marujo WC,Inagaki M,Stratta RJ,Wood RP,Shaw BW Jr

    更新日期:1992-02-01 00:00:00

  • Role of the thymus in transplantation tolerance in miniature swine. III. Surgical manipulation of the thymus interferes with stable induction of tolerance to class I-mismatched renal allografts.

    abstract:BACKGROUND:Previous studies have demonstrated that long-term tolerance of class I mismatched renal allografts in miniature swine is induced by a short course of cyclosporine (CyA), and that a total thymectomy 21 days before transplantation abrogates the induction of stable tolerance. We have now examined the effects of...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199904270-00005

    authors: Yamada K,Ierino FL,Gianello PR,Shimizu A,Colvin RB,Sachs DH

    更新日期:1999-04-27 00:00:00

  • Transgenic Expression of Human CD46 on Porcine Endothelium: Effect on Coagulation and Fibrinolytic Cascades During Ex Vivo Human-to-Pig Limb Xenoperfusions.

    abstract:BACKGROUND:Dysregulation of the coagulation system due to inflammatory responses and cross-species molecular incompatibilities represents a major obstacle to successful xenotransplantation. We hypothesized that complement inhibition mediated by transgenic expression of human CD46 in pigs might also regulate the coagula...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0000000000000746

    authors: Bongoni AK,Kiermeir D,Schnider J,Jenni H,Garimella P,Bähr A,Klymiuk N,Wolf E,Ayares D,Voegelin E,Constantinescu MA,Seebach JD,Rieben R

    更新日期:2015-10-01 00:00:00

  • Hepatitis C infection, time in renal-replacement therapy, and outcome after kidney transplantation.

    abstract:BACKGROUND:Hepatitis C virus (HCV) infection is common in kidney transplantation and is known to affect long-term patient and graft survival, as is time in renal-replacement therapy (RRT). The aim of this study was to investigate HCV in relation to time in RRT and its impact on outcome after transplantation. METHODS:A...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000131948.29742.24

    authors: Bruchfeld A,Wilczek H,Elinder CG

    更新日期:2004-09-15 00:00:00

  • Comparative analysis of live liver donation risk using a comprehensive grading system for severity.

    abstract::We investigated whether right lobe (RL) liver donation is associated with a higher incidence or severity of donor complications than left lobe (LL) liver and left lateral segment (LLS) liver donations. We studied 80 living donors: 35 RL liver donors and 45 LL/LLS liver donors. A modification of the Clavien classificat...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000129406.35825.6d

    authors: Salvalaggio PR,Baker TB,Koffron AJ,Fryer JP,Clark L,Superina RA,Blei AT,Abecassis MM

    更新日期:2004-06-15 00:00:00

  • Cyclosporine A inhibits the expression of costimulatory molecules on in vitro-generated dendritic cells: association with reduced nuclear translocation of nuclear factor kappa B.

    abstract:BACKGROUND:The maturation of dendritic cells (DC) is influenced by various factors, in particular cytokine-mediated signaling events. These include modulation of the activation of nuclear factor kappa B (NF-kappaB), which controls the transcription of genes encoding major histocompatibility complex (MHC) antigens, and ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199911150-00007

    authors: Lee JI,Ganster RW,Geller DA,Burckart GJ,Thomson AW,Lu L

    更新日期:1999-11-15 00:00:00

  • Effects of combination cyclosporine/mizoribine immunosuppression on canine renal allograft recipients.

    abstract::Heterotopic renal allografts following bilateral nephrectomies were placed in 21 healthy mongrel dogs. One group of 11 dogs received cyclosporine (5 mg/kg/24 hr, orally), and 1 group of 10 dogs received cyclosporine and mizoribine (5 mg/kg and 3 mg/kg/24 hr, orally). Body weights, blood cell counts, serum chemistry pr...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198805000-00003

    authors: Gregory CR,Gourley IM,Cain GR,Broaddus TW,Cowgill LD,Willits NH,Patz JD,Ishizaki G

    更新日期:1988-05-01 00:00:00

  • In situ expression of tumor necrosis factor-alpha, interferon-gamma, and interleukin-2 receptors in renal allograft biopsies.

    abstract::The production and release of cytokines and their receptors are of critical importance in mediating graft injury. In order to evaluate the expression of cytokines in renal allograft biopsies, we performed immunocytochemical studies to detect activated cells positive for TNF-alpha, IFN-gamma, and IL-2R, using an alkali...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199212000-00015

    authors: Noronha IL,Eberlein-Gonska M,Hartley B,Stephens S,Cameron JS,Waldherr R

    更新日期:1992-12-01 00:00:00

  • Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression.

    abstract:BACKGROUND:The aim of our study was to examine, in a recent cohort of kidney transplant recipients who have received modern immunosuppressive therapy, the respective role of cold ischemia time (CIT) and delayed graft function (DGF) on acute rejection (AR) rates and long-term graft survival. METHODS:We retrospectively ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0b013e318169c29e

    authors: Mikhalski D,Wissing KM,Ghisdal L,Broeders N,Touly M,Hoang AD,Loi P,Mboti F,Donckier V,Vereerstraeten P,Abramowicz D

    更新日期:2008-04-15 00:00:00

  • Allograft rejection in athymic nude rats by transferred T cell subsets. II. The response of naive CD4+ and CD8+ thoracic duct lymphocytes to an isolated MHC class I disparity.

    abstract::Athymic PVG-rnu/rnu (RT1c) rats were grafted with skin bearing isolated MHC disparities 7-14 days in advance of cell transfer. The ability of naive CD4+ or CD8+ thoracic duct lymphocytes to induce rejection was assessed by adoptive transfer of one or both T cell subsets into nude recipients bearing congenic PVG.r1 (MH...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Bell EB,Rejali D,Whitby EH,Sparshott SM,Yang CP

    更新日期:1990-10-01 00:00:00

  • Recipients' perceptions of their transplanted kidneys.

    abstract:BACKGROUND:The literature indicates few studies on kidney patients' perception of the donor kidney. In light of this fact, we decided to explore this issue with adult patients. METHODS:We carried out a phenomenological study with 40 adult kidney patients. RESULTS:In this study, three main themes became apparent: the ...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.tp.0000168149.95310.6e

    authors: Buldukoglu K,Kulakac O,Kececioglu N,Alkan S,Yilmaz M,Yucetin L

    更新日期:2005-08-27 00:00:00

  • Tolerance induction in a fully allogeneic combination using anti-T cell receptor-alpha beta monoclonal antibody, low dose irradiation, and donor bone marrow transfusion.

    abstract::In a murine strain combination disparate in both H-2 antigens and minor histocompatibility antigens consisting of C57BL/6 (B6; H-2b, Mls-1b) mice as recipients and AKR/J (AKR; H-2k, Mls-1a) mice as donors, we reported that the administration of anti-TCR-alpha beta mAb nonspecifically suppresses the ability to reject a...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Nomoto K,Yung-Yun K,Omoto K,Umesue M,Murakami Y,Matsuzaki G,Nomoto K

    更新日期:1995-02-15 00:00:00

  • Beneficial effect of cyclosporine pretreatment in canine liver ischemia. Enzymatic and electronmicroscopic studies.

    abstract::The effect of cyclosporine on hepatic ischemia was investigated. Hepatic ischemia was produced for 90 min in mongrel dogs. Experimental dogs were divided into three groups as follows: group A (control group), group B (CsA pretreatment group), group C (CsA posttreatment group). CsA was administered at a dose of 10 mg/k...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-199107000-00024

    authors: Hayashi T,Nagasue N,Kohno H,Chang YC,Nakamura T

    更新日期:1991-07-01 00:00:00

  • Induction of immune alterations and successful renal transplantation with a simplified method of donor-specific blood transfusion.

    abstract::We developed a new and simplified donor-specific blood transfusion (DSBT) protocol for prospective kidney transplant recipients from one-haplotype-mismatched related donors. Prospective kidney donors gave 450 ml of blood in a quad-pack unit, and the blood was stored in a blood bank. Twenty-five patients were transfuse...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/00007890-198411000-00012

    authors: Cheigh JS,Suthanthiran M,Kaplan M,Evelyn M,Riggio RR,Fotino M,Schechter N,Wolf CF,Stubenbord WT,Stenzel KH

    更新日期:1984-11-01 00:00:00

  • Is selenium deficiency an important risk factor for chronic graft nephropathy? A pilot study.

    abstract:BACKGROUND:Lipid peroxidation by free radicals is a key step in the development of atherosclerosis. Chronic graft nephropathy (CGN) is a common cause of allograft failure and shares many histologic features with atherosclerosis. Although hyperlipidemia is a common finding in renal transplant recipients, not all patient...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/01.TP.0000090750.47058.24

    authors: Morris-Stiff GJ,Oleesky D,Jurewicz WA

    更新日期:2003-10-15 00:00:00

  • A human model of xenogeneic graft-versus-host disease in SCID mice engrafted with human peripheral blood lymphocytes.

    abstract::Despite previous attempts there is currently no suitable animal model available for xenogeneic graft versus host disease (XGVHD) mediated via human immunocompetent cells. Recently, we have developed an efficient protocol to engraft SCID mice with human peripheral blood lymphocytes (Hu-PBLs). The engraftment efficiency...

    journal_title:Transplantation

    pub_type: 杂志文章

    doi:

    authors: Sandhu JS,Gorczynski R,Shpitz B,Gallinger S,Nguyen HP,Hozumi N

    更新日期:1995-07-27 00:00:00