Summary

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• This summary is based on the review of 16 systematic review(s)/meta-analysis(es). ^[1-16]
• Combining genotype-informed and pharmacokinetic model-based dosing for tacrolimus in pediatric solid organ transplant (SOT) recipients shows potential for dosing accuracy, though evidence on the optimization of initial and subsequent doses remains limited.
• GLP-1 receptor agonists (GLP-1RAs) significantly reduced urine protein ratio and hemoglobin A1c levels in kidney transplant recipients (KTRs) without impacting tacrolimus levels, suggesting possible benefits for metabolic and glycemic control in this population.
• Mammalian target of rapamycin (mTOR) inhibitors were effective in a reduced tacrolimus regimen but increased rejection rates when calcineurin inhibitors were avoided or steroids withdrawn early. Once-daily tacrolimus was comparable to twice-daily formulations in acute rejection and renal function outcomes for de novo renal transplant patients.
• The presence of the CYP3A4*22 allele was associated with higher plasma dose-adjusted trough concentrations (C(0)/D) of tacrolimus, indicating that lower doses may achieve therapeutic levels, supporting dose individualization based on genetic polymorphisms.
• Tacrolimus is associated with nephrotoxicity, new-onset diabetes after transplantation (NODAT), and gastrointestinal toxicity; pharmacokinetic variability within and between individuals complicates management despite therapeutic drug monitoring.
• GLP-1 receptor agonists (GLP-1RAs) in kidney transplant recipients had side effects including nausea and vomiting (17.6%), diarrhea (7.6%), and injection site pain (5.4%).
• Belatacept increased risks of acute rejection and certain infections compared to tacrolimus, while mTOR inhibitors combined with reduced-dose tacrolimus showed increased rejection rates without higher rates of graft failure or death.