Monitoring immunosuppression after liver transplantation : development of individualized Bayesian limited sampling monitoring

摘要: After using C0-monitoring as the tool for therapeutic drug monitoring of cyclosporine many years, studies suggested that C2-monitoring might be better. switching 31 liver transplant patients from C0 via C2 to flexible limited sampling models (LSM), combinations blood time points 0+2h (r²=0.94); 0+1+2h 0+1+3h (r²=0.92); 0+2+3h (r²=0.92) and 0+1+2+3h (r²=0.96) showed excellent correlation with AUC0-12h acceptable precision bias. When evaluating LSM0+1+2+3h model in 18 months after introduction there was no significant change average dose creatinine clearance, compared previous C2-monitoring. Especially LSM0+2h optimal terms accuracy, ease-of-use intrapatient variability. When optimizing tacrolimus calculating formulas (LSF) LSM single multiple-point good correlations AUC0-12h. The best point calculation estimating systemic exposure were 4h (r²=0.97) 6h (r²=0.97). During study pharmacokinetic behaviour MMF we found a wide range MPA clearance population (8.08–57.47 L/h). Looking at possible sources this variability divided our group, based on clinical selection, into two groups (with without calcineurin inhibitors). These used further development MPA. combination 0-½-1-2h very trapezoidal both models, bias precision.