Immunosuppressant drug concentration monitoring improves the quality of life of organ transplant patients
September 15, 2014 Source: People's Network
Window._bd_share_config={ "common":{ "bdSnsKey":{ },"bdText":"","bdMini":"2","bdMiniList":false,"bdPic":"","bdStyle":" 0","bdSize":"16"},"share":{ }};with(document)0[(getElementsByTagName('head')[0]||body).appendChild(createElement('script')) .src='http://bdimg.share.baidu.com/static/api/js/share.js?v=89860593.js?cdnversion='+~(-new Date()/36e5)];Organ transplantation is a common treatment for end-stage organ failure. The rejection of the recipient immune system by recognizing the transplanted organ as a foreign tissue is the main challenge after transplantation, and it is also an important cause of graft failure and death. Recently, Roche Diagnostics announced that the Elecsys Immunosuppressant (ISDs) drug concentration monitoring project was officially approved for listing in China in August. Chinese organ transplant patients may get better treatment management.
The data shows that there are about 10,000 organ transplants per year in China, and the cumulative transplant has exceeded 100,000. Among them, 69% were kidney transplants, followed by liver, heart, lung and pancreas.
Professor Cai Ming, deputy director of the Institute of Organ Transplantation, General Hospital of the General Staff of the People's Liberation Army (No. 309 Hospital) said: "The effective rejection of various rejections in the immune system after transplantation is the key to improving the success rate of transplant surgery. Immunosuppression Drugs (ISDs) can be used to block the immune system of different mechanisms of action, thereby reducing rejection of grafts. Over the past 30 years, ISDs have effectively inhibited organ rejection after transplantation and improved organ transplantation. Receptor survival rate. Nearly 60% of adult kidney transplant patients have a survival rate of more than 10 years, and liver transplantation has a 5-year survival rate of 70-75%."
However, the concentration of immunosuppressive drugs must be maintained within an effective and safe dosage range in order to promote the treatment. Excessive concentration of ISDs can lead to serious side effects, including inhibition of infection and tumor immunity. Decreased; and if the concentration of ISDs is too low, organ rejection will occur. In addition, because transplant patients have different functional differences such as age, weight, gastrointestinal tract, etc., and are affected by many factors such as genetic factors, environmental factors and drug interactions, there is a big difference in the metabolic process of drugs in patients.
Cai Ming said: "Immunostatic inhibitors are usually at a very narrow and variable therapeutic concentration level. When using drugs, the appropriate immunosuppressive agents should be selected according to the individual indicators of the transplanted patients, and the immunosuppressants should be adjusted according to the monitored drug concentration. The dosage should also be based on the metabolism of the drug in the body to choose the time of administration and the route of administration. Therefore, regular monitoring of the concentration of immunosuppressive drugs has important guiding significance for the selection of drug treatment strategies for organ transplant patients, and can assist doctors. Optimize the dose in a very narrow therapeutic window to ensure effective dose prevention of organ rejection and to avoid excessive doses leading to serious side effects."
Professor Pan Baishen, director of the Department of Clinical Laboratory of Zhongshan Hospital affiliated to Fudan University, pointed out: "ISDs monitor only drugs with significant differences between individuals in pharmacokinetics, including cyclosporine, tacrolimus, sirolimus, everolimus and Mycophenolic acid, its pharmacological differences can lead to drug concentration is too high or too low. The frequency of postoperative drug monitoring in organ transplant patients depends mainly on the three factors of drug type, transplanted organs and patient health. Early stage after transplantation The frequency is high, it is generally recommended to monitor every day for the first 2 weeks, and then gradually decrease with time. During the blood concentration monitoring process, the monitored values ​​should be consistent with the effective blood concentration values ​​to ensure clinical The effectiveness and safety of the drug. This also puts higher requirements on the accuracy and stability of drug testing products."
It is understood that Roche's diagnosis of Elecsys cyclosporine and tacrolimus monitoring project has been approved by the China Food and Drug Administration (CFDA), and the existing immunosuppressant mycophenolic acid concentration test program can meet most drugs. The need for concentration monitoring. The latest cyclosporine and tacrolimus monitoring programs are available on all Roche immunoassay platforms with less total variability, better accuracy and a wider detection threshold. At the same time, the same pretreatment liquid and pretreatment process are used for different tests, and the test results can be obtained in 18 minutes, which improves the laboratory work efficiency.
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