Switching to tacrolimus extended-release improved the effectiveness of immunosuppressive therapy in a heart transplant patient: A case report
Summary We report on a 25-year-old female heart transplant patient who presented with recurrent episodes of cellular rejection due to decreased adherence to immunosuppressive therapy. She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunos...
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| Veröffentlicht in: | Journal of cardiology cases 2012-07, Vol.6 (1), p.e26-e29 |
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| creator | Nunoda, Shinichi, MD, PhD, FJCC Suwa, Kuniaki, MD Shitakura, Kazunobu, MD Kikuchi, Tomoko, MD Nakajima, Shun, MD Hattammaru, Miwa, MD Mitsuhashi, Tetsuya, MD Okajima, Kiyotaka, MD Kubo, Yutaka, MD, PhD Otsuka, Kuniaki, MD, PhD |
| description | Summary We report on a 25-year-old female heart transplant patient who presented with recurrent episodes of cellular rejection due to decreased adherence to immunosuppressive therapy. She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunosuppressive therapy, switching to the once-daily extended-release formulation of tacrolimus was performed in a step-wise fashion. First, the twice-daily formulation of cyclosporin A was replaced with the twice-daily preparation of tacrolimus. When the trough blood levels of tacrolimus reached a plateau in the range of 5.0 ng/mL, it was changed to the once-daily extended-release formulation of tacrolimus after confirming the absence of new rejection episodes. There were no significant changes in renal function before and after the switch. After being discharged from the hospital, the patient made significant advancements in adherence to immunosuppressive therapy. Her subsequent clinical course was uneventful, with no adverse events observed. Most patients who undergo solid organ transplantation must receive lifelong immunosuppressive therapy. This case demonstrates that conversion to the extended-release formulation of tacrolimus from other calcineurin inhibitor preparations is a reasonable choice to consider in the management of compromised immunosuppressive therapy adherence in heart transplant patients during the late posttransplant period. |
| doi_str_mv | 10.1016/j.jccase.2012.04.003 |
| format | Article |
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She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunosuppressive therapy, switching to the once-daily extended-release formulation of tacrolimus was performed in a step-wise fashion. First, the twice-daily formulation of cyclosporin A was replaced with the twice-daily preparation of tacrolimus. When the trough blood levels of tacrolimus reached a plateau in the range of 5.0 ng/mL, it was changed to the once-daily extended-release formulation of tacrolimus after confirming the absence of new rejection episodes. There were no significant changes in renal function before and after the switch. After being discharged from the hospital, the patient made significant advancements in adherence to immunosuppressive therapy. Her subsequent clinical course was uneventful, with no adverse events observed. Most patients who undergo solid organ transplantation must receive lifelong immunosuppressive therapy. This case demonstrates that conversion to the extended-release formulation of tacrolimus from other calcineurin inhibitor preparations is a reasonable choice to consider in the management of compromised immunosuppressive therapy adherence in heart transplant patients during the late posttransplant period.</description><identifier>ISSN: 1878-5409</identifier><identifier>EISSN: 1878-5409</identifier><identifier>DOI: 10.1016/j.jccase.2012.04.003</identifier><identifier>PMID: 30532941</identifier><language>eng</language><publisher>Japan: Elsevier Ltd</publisher><subject>Adherence ; Cardiac transplantation ; Cardiovascular ; Case Report ; Tacrolimus extended-release</subject><ispartof>Journal of cardiology cases, 2012-07, Vol.6 (1), p.e26-e29</ispartof><rights>Japanese College of Cardiology</rights><rights>2012 Japanese College of Cardiology</rights><rights>2012 Japanese College of Cardiology. 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She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunosuppressive therapy, switching to the once-daily extended-release formulation of tacrolimus was performed in a step-wise fashion. First, the twice-daily formulation of cyclosporin A was replaced with the twice-daily preparation of tacrolimus. When the trough blood levels of tacrolimus reached a plateau in the range of 5.0 ng/mL, it was changed to the once-daily extended-release formulation of tacrolimus after confirming the absence of new rejection episodes. There were no significant changes in renal function before and after the switch. After being discharged from the hospital, the patient made significant advancements in adherence to immunosuppressive therapy. Her subsequent clinical course was uneventful, with no adverse events observed. Most patients who undergo solid organ transplantation must receive lifelong immunosuppressive therapy. This case demonstrates that conversion to the extended-release formulation of tacrolimus from other calcineurin inhibitor preparations is a reasonable choice to consider in the management of compromised immunosuppressive therapy adherence in heart transplant patients during the late posttransplant period.</description><subject>Adherence</subject><subject>Cardiac transplantation</subject><subject>Cardiovascular</subject><subject>Case Report</subject><subject>Tacrolimus extended-release</subject><issn>1878-5409</issn><issn>1878-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqFUttu1DAQjRCIVqV_gJB_IKlvyXp5QKoqblIlHgoSb5Zjj7sOiR3Zzpb9CP65Dgul8IJfbM34nJk5Z6rqJcENwaS7GJpBa5WgoZjQBvMGY_akOiViI-qW4-3TR--T6jylAZfDCBeteF6dMNwyuuXktPpxc-ey3jl_i3JAWekYRjctCcH3DN6AqSOMUCohN80x7MGgvAME1oLObg8eUkLBluy0-JCWeY4lUhLrt6jmA3IeKbQDFTPKUfk0j8pnNKvswOfX6BKtc6AIc4j5RfXMqjHB-a_7rPry7u3nqw_19af3H68ur2vNKWe1UBZbBW1rMDFYYK5sa4yyvO-o4UyzbrsxXGwIxtwI0SpNWd_TXpBedApv2Fn15sg7L_0ERpdOohrlHN2k4kEG5eTfGe928jbsZUe7Le1oIeBHgqJXShHsA5ZguTokB3l0SK4OScxlkb_AXj2u-wD67cefxqBMv3cQZdJFJw3GxSK4NMH9r8K_BHp03mk1foMDpCEs0RdlJZGpYOTNuiXrkhD6cz--sntDU73O</recordid><startdate>201207</startdate><enddate>201207</enddate><creator>Nunoda, Shinichi, MD, PhD, FJCC</creator><creator>Suwa, Kuniaki, MD</creator><creator>Shitakura, Kazunobu, MD</creator><creator>Kikuchi, Tomoko, MD</creator><creator>Nakajima, Shun, MD</creator><creator>Hattammaru, Miwa, MD</creator><creator>Mitsuhashi, Tetsuya, MD</creator><creator>Okajima, Kiyotaka, MD</creator><creator>Kubo, Yutaka, MD, PhD</creator><creator>Otsuka, Kuniaki, MD, PhD</creator><general>Elsevier Ltd</general><general>Japanese College of Cardiology</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>201207</creationdate><title>Switching to tacrolimus extended-release improved the effectiveness of immunosuppressive therapy in a heart transplant patient: A case report</title><author>Nunoda, Shinichi, MD, PhD, FJCC ; Suwa, Kuniaki, MD ; Shitakura, Kazunobu, MD ; Kikuchi, Tomoko, MD ; Nakajima, Shun, MD ; Hattammaru, Miwa, MD ; Mitsuhashi, Tetsuya, MD ; Okajima, Kiyotaka, MD ; Kubo, Yutaka, MD, PhD ; Otsuka, Kuniaki, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4243-8af0fae55d01d0804af5ddaf4b62d43c3697d4871004d885ac23bb2b81b86a073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adherence</topic><topic>Cardiac transplantation</topic><topic>Cardiovascular</topic><topic>Case Report</topic><topic>Tacrolimus extended-release</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nunoda, Shinichi, MD, PhD, FJCC</creatorcontrib><creatorcontrib>Suwa, Kuniaki, MD</creatorcontrib><creatorcontrib>Shitakura, Kazunobu, MD</creatorcontrib><creatorcontrib>Kikuchi, Tomoko, MD</creatorcontrib><creatorcontrib>Nakajima, Shun, MD</creatorcontrib><creatorcontrib>Hattammaru, Miwa, MD</creatorcontrib><creatorcontrib>Mitsuhashi, Tetsuya, MD</creatorcontrib><creatorcontrib>Okajima, Kiyotaka, MD</creatorcontrib><creatorcontrib>Kubo, Yutaka, MD, PhD</creatorcontrib><creatorcontrib>Otsuka, Kuniaki, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cardiology cases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nunoda, Shinichi, MD, PhD, FJCC</au><au>Suwa, Kuniaki, MD</au><au>Shitakura, Kazunobu, MD</au><au>Kikuchi, Tomoko, MD</au><au>Nakajima, Shun, MD</au><au>Hattammaru, Miwa, MD</au><au>Mitsuhashi, Tetsuya, MD</au><au>Okajima, Kiyotaka, MD</au><au>Kubo, Yutaka, MD, PhD</au><au>Otsuka, Kuniaki, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Switching to tacrolimus extended-release improved the effectiveness of immunosuppressive therapy in a heart transplant patient: A case report</atitle><jtitle>Journal of cardiology cases</jtitle><addtitle>J Cardiol Cases</addtitle><date>2012-07</date><risdate>2012</risdate><volume>6</volume><issue>1</issue><spage>e26</spage><epage>e29</epage><pages>e26-e29</pages><issn>1878-5409</issn><eissn>1878-5409</eissn><abstract>Summary We report on a 25-year-old female heart transplant patient who presented with recurrent episodes of cellular rejection due to decreased adherence to immunosuppressive therapy. She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunosuppressive therapy, switching to the once-daily extended-release formulation of tacrolimus was performed in a step-wise fashion. First, the twice-daily formulation of cyclosporin A was replaced with the twice-daily preparation of tacrolimus. When the trough blood levels of tacrolimus reached a plateau in the range of 5.0 ng/mL, it was changed to the once-daily extended-release formulation of tacrolimus after confirming the absence of new rejection episodes. There were no significant changes in renal function before and after the switch. After being discharged from the hospital, the patient made significant advancements in adherence to immunosuppressive therapy. Her subsequent clinical course was uneventful, with no adverse events observed. Most patients who undergo solid organ transplantation must receive lifelong immunosuppressive therapy. This case demonstrates that conversion to the extended-release formulation of tacrolimus from other calcineurin inhibitor preparations is a reasonable choice to consider in the management of compromised immunosuppressive therapy adherence in heart transplant patients during the late posttransplant period.</abstract><cop>Japan</cop><pub>Elsevier Ltd</pub><pmid>30532941</pmid><doi>10.1016/j.jccase.2012.04.003</doi><oa>free_for_read</oa></addata></record> |
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| source | Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Adherence Cardiac transplantation Cardiovascular Case Report Tacrolimus extended-release |
| title | Switching to tacrolimus extended-release improved the effectiveness of immunosuppressive therapy in a heart transplant patient: A case report |
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