Case Report: Low Hematocrit Leading to Tacrolimus Toxicity

Article Article scientifique Rapport de cas Case Report: Low Hematocrit Leading to Tacrolimus Toxicity eng 2021-08-16 2021-08-16 author Piletta-Zanin Alexandre 799931 author De Mul Aurélie 903781 author Rock Nathalie 826963 author Lescuyer Pierre 0000-0001-6986-8738 562350 author Samer Caroline Flora 105661 author Rodieux Frédérique 778571 717148 10.3389/fphar.2021.717148 34483924 1663-9812 PMC8415261 https://www.frontiersin.org/articles/10.3389/fphar.2021.717148/full Tacrolimus is a calcineurin inhibitor characterized by a narrow therapeutic index and high intra- and inter-individual pharmacokinetic variability. Therapeutic drug monitoring in whole-blood is the standard monitoring procedure. However, tacrolimus extensively binds to erythrocytes, and tacrolimus whole-blood distribution and whole-blood trough concentrations are strongly affected by hematocrit. High whole-blood tacrolimus concentrations at low hematocrit may result in high unbound plasma concentrations and increased toxicity. We present the case of a 16-year-old girl with kidney and liver transplant in whom low concentrations of tacrolimus in the context of low hematocrit led to significant increase in the dosage of tacrolimus and participate, along with a genetic polymorphism of ABCB1 , in nephrotoxicity. ABCB1 Hematocrit Monitoring Pharmacogenetic Pharmacokinetic Subtherapeutic Tacrolimus Toxicity Dewey 616 Dewey 617 Dewey 618 56 Département de médecine 221 58 Département de pédiatrie, gynécologie et obstétrique 223 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 211 Chimie et protéomique clinique 270 1280 Pharmaco-omiques et médecine de précision 1003 Frontiers in pharmacology 12 20268a24-b85e-4a18-93cf-54e61b0f8ea6 Article (Published version) Public Article-scientifique-from-unpaywall.pdf 1285137 application/pdf CC BY-4.0 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Case Report: Low Hematocrit Leading to Tacrolimus Toxicity	Frontiers in pharmacology			2021	152	69

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Piletta-Zanin, Alexandre