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Challenges with non-descriptive compliance labeling of end-stage renal disease patients in accessibility for renal transplantation

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World Journal of Nephrology 2024年第1期13卷 9-13页

作者： Benjamin Peticca Tomas M Prudencio samuel G Robinson sunil s karhadkar Department of surgery Lewis Katz School of Medicine at Temple University HospitalPhiladelphiaPA 19140United States

Non-descriptive and convenient labels are uninformative and unfairly project blame onto *** language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of *** such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving *** labels fail to capture all the circum-stances surrounding a patient’s inability to follow their care regimen,trivialize social determinants of health variables,and bring unsubstantiated subjectivity into decisions regarding organ ***,insufficient Medicare coverage has forced patients to ration or stop taking medication,leading to allograft failure and their subsequent diagnosis of *** argue that perpetuating non-descriptive language adds little substantive information,in-creases subjectivity to the organ allocation process,and plays a major role in reduced access to *** patients with existing barriers to care,such as racial/ethnic minorities,these effects may be even more *** committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.

关键词： End-stage renal disease Compliance Labeling social determinants

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Dosing strategies for de novo once-daily extended release tacrolimus in kidney transplant recipients based on CYP3A5 genotype

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World Journal of Transplantation 2023年第6期13卷 368-378页

作者： Adam Diamond sunil karhadkar Kenneth Chavin serban Constantinescu Kwan N.Lau Oscar Perez-Leal Kerry Mohrien Nicole sifontis Antonio Di Carlo Department of Pharmacy Temple University HospitalPhiladelphiaPA 19140United States Department of surgery Temple University HospitalPhiladelphiaPA 19140United States Department of Medicine Temple University School of MedicinePhiladelphiaPA 19140United States Department of Pharmaceutical sciences Jayne Haines Center for Pharmacogenomics and Drug SafetyTemple University School of PharmacyPhiladelphiaPA 19140United States Department of Pharmacy Practice Temple University School of PharmacyPhiladelphiaPA 19140United States

BACKGROUND Tacrolimus extended-release tablets have been Food and Drug Administrationapproved for use in the de novo kidney transplant *** requirements often vary for tacrolimus based on several factors including variation in metabolism based on CYP3A5 *** who express CYP3A5 often require higher dosing of immediate-release tacrolimus,but this has not been established for tacrolimus extended-release tablets in the de novo *** To obtain target trough concentrations of extended-release tacrolimus in de novo kidney transplant recipients according to CYP3A5 *** single-arm,prospective,single-center,open-label,observational study(***:NCT037-13645).Life cycle pharma tacrolimus(LCPT)orally once daily at a starting dose of 0.13 mg/kg/day based on actual body *** weight is more than 120%of ideal body weight,an adjusted body weight was *** dose was adjusted to maintain tacrolimus trough concentrations of 8-10 ng/*** analysis of CYP3A5 genotype was performed at study *** Mean time to therapeutic tacrolimus trough concentration was longer in CYP3A5 intermediate and extensive metabolizers vs CYP3A5 non-expressers(6 d vs 13.5 d vs 4.5 d;P=0.025).Mean tacrolimus doses and weight-based doses to achieve therapeutic concentration were higher in CYP3A5 intermediate and extensive metabolizers vs CYP3A5 non-expressers(16 mg vs 16 mg vs 12 mg;P=0.010)(0.20 mg/kg vs 0.19 mg/kg vs 0.13 mg/kg;P=0.018).CYP3A5 extensive metabolizers experienced lower mean tacrolimus trough concentrations throughout the study period compared to CYP3A5 intermediate metabolizers and non-expressers(7.98 ng/mL vs 9.18 ng/mL vs 10.78 ng/mL;P=00.008).No differences were identified with regards to kidney graft function at 30-d *** adverse events were reported for 13(36%)*** Expression of CYP3A5 leads to higher starting doses and incremental dosage titration of extended-release

关键词： Immunosuppression Kidney transplant Dosing Tacrolimus Therapeutic drug monitoring Genotype

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