TY - JOUR
T1 - Immunosuppressive Drug Levels in Liver Transplant Recipients
T2 - Impact in Decision Making
AU - Kourkoumpetis, Themistoklis
AU - Levitsky, Josh
N1 - Publisher Copyright:
© 2019 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
PY - 2019
Y1 - 2019
N2 - To prevent rejection, liver transplant providers largely base their management decisions on their clinical impression and pharmacokinetics. Clinical impression relies on assessing graft function, liver enzymes, and biopsy. High immunosuppressive drug levels, although minimizing rejection, are related to significant side effects such as nephrotoxicity and metabolic syndrome, contributing to long-term morbidity and mortality. Similarly, levels that are lower than necessary can decrease the rate of side effects with a potential toll on rejection and graft survival. Herein, the authors present an update on immunosuppressive drug level monitoring and manipulation strategies according to different scenarios and time from transplant. They also provide a brief overview of next level immunosuppression monitoring strategies that aim to properly balance rejection rates with drug side effect profiles.
AB - To prevent rejection, liver transplant providers largely base their management decisions on their clinical impression and pharmacokinetics. Clinical impression relies on assessing graft function, liver enzymes, and biopsy. High immunosuppressive drug levels, although minimizing rejection, are related to significant side effects such as nephrotoxicity and metabolic syndrome, contributing to long-term morbidity and mortality. Similarly, levels that are lower than necessary can decrease the rate of side effects with a potential toll on rejection and graft survival. Herein, the authors present an update on immunosuppressive drug level monitoring and manipulation strategies according to different scenarios and time from transplant. They also provide a brief overview of next level immunosuppression monitoring strategies that aim to properly balance rejection rates with drug side effect profiles.
KW - drug level monitoring
KW - immune monitoring
KW - immunosuppression
KW - liver transplant
UR - http://www.scopus.com/inward/record.url?scp=85073582297&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073582297&partnerID=8YFLogxK
U2 - 10.1055/s-0039-1688443
DO - 10.1055/s-0039-1688443
M3 - Article
C2 - 31041787
AN - SCOPUS:85073582297
VL - 39
SP - 414
EP - 421
JO - Seminars in Liver Disease
JF - Seminars in Liver Disease
SN - 0272-8087
IS - 4
ER -