ArticlePediatric nephrology (Berlin, Germany)2019
The potential impact of hematocrit correction on evaluation of tacrolimus target exposure in pediatric kidney transplant patients.
Article in Pediatric nephrology (Berlin, Germany), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04292418 (Predictors of Rejection in Pediatric Kidney Transplantation), which is not on this map. Cited by 16 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Predictors of Rejection in Pediatric Kidney Transplantation
Who cites it
16 citing papers in PubMed, 22 citations in OpenAlex.
- Unbound Plasma, Total Plasma, and Whole-Blood Tacrolimus Pharmacokinetics Early After Thoracic Organ Transplantation.Clinical pharmacokinetics · 2020Trial
- A Population Pharmacokinetic Model Does Not Predict the Optimal Starting Dose of Tacrolimus in Pediatric Renal Transplant Recipients in a Prospective Study: Lessons Learned and Model Improvement.Clinical pharmacokinetics · 2020Trial
- Structured Evaluation of Model-Informed Precision Dosing of Mycophenolic Acid and Tacrolimus in Pediatric Patients with Kidney Disease.Clinical pharmacokinetics · 2026Article
- A Review of Population Pharmacokinetic Models and Dosing Algorithms Assessing the Influence of CYP3A5 Genotype and Other Clinical Covariates on Tacrolimus Pharmacokinetics.Clinical pharmacokinetics · 2026Review
- Comparing Whole-Blood and Plasma Tacrolimus Intra-Patient Variability for Predicting Allograft Rejection in Kidney Transplantation.Clinical and translational science · 2026Article
- Delayed Drug-Drug Interaction Between Antiviral Drugs and Tacrolimus in a Pancreatic Islet Transplant Recipient With SARS-CoV-2 Pneumonia.Therapeutic drug monitoring · 2025Article
- Plasma Versus Whole Blood Tacrolimus Concentrations and Health-Related Quality of Life in Kidney Transplant Recipients.Pharmaceutics · 2025Article
- Effect of Hematopoietic Stem Cell Transplantation Regimen on Tacrolimus Pharmacokinetics.Current therapeutic research, clinical and experimental · 2025Article
- Optimizing the initial tacrolimus dosage in Chinese children with lung transplantation within normal hematocrit levels.Frontiers in pediatrics · 2024Article
- Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review.Pediatric nephrology (Berlin, Germany) · 2024Review
- Guiding the starting dose of the once-daily formulation of tacrolimus in "Frontiers in pharmacology · 2024Article
- A Joint Pharmacokinetic Model for the Simultaneous Description of Plasma and Whole Blood Tacrolimus Concentrations in Kidney and Lung Transplant Recipients.Clinical pharmacokinetics · 2023Article
- Importance of Pharmacogenetics and Drug-Drug Interactions in a Kidney Transplanted Patient.Life (Basel, Switzerland) · 2023Article
- Population pharmacokinetics and genetics of oral meltdose tacrolimus (Envarsus) in stable adult liver transplant recipients.British journal of clinical pharmacology · 2021Article
- Precision Dosing for Tacrolimus Using Genotypes and Clinical Factors in Kidney Transplant Recipients of European Ancestry.Journal of clinical pharmacology · 2021Observational
- Case Report: Low Hematocrit Leading to Tacrolimus Toxicity.Frontiers in pharmacology · 2021Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTacrolimus is an important immunosuppressive agent with high intra- and inter-individual pharmacokinetic variability and a narrow therapeutic index. As tacrolimus extensively accumulates in erythrocytes, hematocrit is a key factor in the interpretation of tacrolimus whole blood concentrations. However, as hematocrit values in pediatric kidney transplant patients are highly variable after kidney transplantation, translating whole blood concentration targets without taking hematocrit into consideration is theoretically incorrect. The aim of this study is to evaluate the potential impact of hematocrit correction on tacrolimus target exposure in pediatric kidney transplant patients.
methodsData were obtained from 36 pediatric kidney transplant patients. Two hundred fifty-five tacrolimus whole blood samples were available, together responsible for 36 area under the concentration-time curves (AUCs) and trough concentrations. First, hematocrit corrected concentrations were derived using a formula describing the relationship between whole blood concentrations, hematocrit, and plasma concentrations. Subsequently, target exposure was evaluated using the converted plasma target concentrations. Ultimately, differences in interpretation of target exposure were identified and evaluated.
resultsIn total, 92% of our patients had lower hematocrit (median 0.29) than the reference value of adult kidney transplant patients. A different evaluation of target exposure for either trough level, AUC, or both was defined in 42% of our patients, when applying hematocrit corrected concentrations.
conclusionA critical role for hematocrit in therapeutic drug monitoring of tacrolimus in pediatric kidney transplant patients is suggested in this study. Therefore, we believe that hematocrit correction could be a step towards improvement of tacrolimus dose individualization.
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