Therapeutic Drug Monitoring of Tacrolimus-Personalized Therapy in Heart Transplantation: New Strategies and Preliminary Results in Endomyocardial Biopsies
U.O.S Epidemiologia Clinica e Biostatistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Barbara Cattadori
U.O.C. di Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Andrea Rapagnani
Unità di Chirurgia Cardiaca, Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, 27100 Pavia, Italy
Centro Malattie Genetiche Cardiovascolari, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Eloisa Arbustini
Centro Malattie Genetiche Cardiovascolari, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Carlo Pellegrini
Unità di Chirurgia Cardiaca, Dipartimento di Scienze Clinico Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia—U.O.C. di Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Tacrolimus (TAC) is an immunosuppressant drug approved both in the US and in the EU, widely used for the prophylaxis of organ rejection after transplantation. This is a critical dose drug: low levels in whole blood can lead to low exposure and a high risk of acute rejection, whereas overexposure puts patients at risk for toxicity and infection. Both situations can occur at whole-blood concentrations considered to be within the narrow TAC therapeutic range. We assumed a poor correlation between TAC trough concentrations in whole blood and the incidence of acute rejection; therefore, we propose to study TAC concentrations in endomyocardial biopsies (EMBs). We analyzed 70 EMBs from 18 transplant recipients at five scheduled follow-up visits during the first year post-transplant when closer TAC monitoring is mandatory. We observed five episodes of acute rejection (grade 2R) in three patients (2 episodes at 0.5 months, 2 at 3 months, and 1 at 12 months), when TAC concentrations in EMBs were low (63; 62; 59; 31; 44 pg/mg, respectively), whereas concentrations in whole blood were correct. Our results are preliminary and further studies are needed to confirm the importance of this new strategy to prevent acute rejection episodes.
