| ObjectiveObjective to investigate the changes of concentration/dose of tacrolimus value(C0/D)in CYP3A5 kidney transplant recipients of different genotypes of tacrolimus sustained-release capsules,and compare the blood concentration and C0/D value and the difference and correlation between creatinine and the incidence of adverse reactions between different genotypes,so as to provide a reference for the rationalized medication of tacrolimus sustained-release capsules for kidney transplant recipients.MethodThirty-one adult recipients who received renal transplantation and were treated by ’Tacrolimus sustained release capsules+Mycophenolate mofetil(MMF)+Corticosteroids’ in the First Affiliated Hospital of Zhengzhou University from August 2019 to February 2020 were retrospectively analyzed.The patients were divided into two groups according to CYP3A5*1/*1,*1/*3 as phenotype and*3/*3 as non phenotype.The whole blood trough concentration of tacrolimus was measured at different time points after operation,and the biochemical indexes of serum creatinine,glomerular filtration rate(GFR),liver function(ALT)and blood glucose were recorded,Linear regression analysis was used to analyze the related factors of tacrolimus C0/D value.Result1.Preoperative age,sex,weight,blood creatinine,liver function,and kidney function of recipients in the fast metabolizer group(*1/*1 type and*1/*3 type)and slow metabolizer group(*3/*3 type)There were no statistically significant differences in function,hemoglobin and albumin levels(P>0.05).2.Among the 31 patients,CYP3A5*1/*1 type was 2 cases(6.5%),*1/*3 type was 10 cases(32.2%)and*3/*3 type was 19 cases(61.3%).3.Under the condition that there was no significant difference in the medication of tacrolimus sustained-release capsules after kidney transplantation,the FK506 blood concentration of the slow metabolizer group were significantly higher than those of the fast metabolizer group in the early postoperative period(P<0.05).4.The concentration-dose ratio(C0/D)of slow metabolizer recipients is higher than that of fast metabolizer recipients within one year after surgery,and there are statistical differences at 7d,2,6,8,10,and 12m(P<0.05).5.There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients.ConclusionThe CYP3A5 gene polymorphism in recipients had a significant effect on the Tac blood concentration and C0/D value in patients who took tacrolimus sustained-release capsules after renal transplantation.To achieve the target concentration,the fast metabolizer carrying the CYP3A5*1 gene requires a higher dose of medication than the homozygous slow metabolizer with genotype*3/*3.In the comparison of C0/D value,the fast metabolizer group was significantly lower than the slow metabolizer group.Clinically,a personalized dosing regimen can be made according to the patient’s CYP3A5 genotype. |
PDF Full Text Request