December 19, 2011

Monitoring Nonadherence and Acute Rejection with Variation in Blood Immunosuppressant Levels in Pediatric Renal Transplantation.


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Acute rejection related to non-adherence to treatment after transplant remains a barrier to optimal outcomes. This study builds on prior literature which asserts that monitoring variation of drug levels is a viable method to reliably detect nonadherence and prevent rejection in pediatric patients. Investigators followed 46 pediatric renal transplant recipients and measured tacrolimus and mycophenolic acid trough levels 1 through 12 months post-transplant, and calculated standard deviation and percent coefficient of variation. They found that high tacrolimus percent coefficient of variation correlated with increased risk for rejection, and that this appears to be a superior marker than standard deviation alone for assessing mediation nonadherence. Future research is needed to validate this method with outcomes after transplant beyond the first year. Investigations to ascertain how much of this variation is due to nonadherence or other biological/pharmacogenetic factors will help assess whether these tools can effectively predict late rejection due to nonadherence and ultimately improve long-term graft function.

Renal Transplantation

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