Monografia (especialização)
O uso do tacrolimo no transplante hepático
Fecha
2012-04-20Autor
Camilla dos Santos Pinheiro
Institución
Resumen
The first attempt in human liver transplant was performed in the United States, in
Denver, Colorado, by Thomas Starzl in 1963. The onset of clinical
immunosuppression in 60 years has contributed significantly to the development of
transplant programs. The use of glucocorticoids associated with azathioprine
remained as the main immunosuppressant drugs until the early '80s, when
cyclosporine was introduced in the U.S. market. From 90 years of other
immunosuppressive agents were marketed, including tacrolimus. The widespread
use of new immunosuppressive drugs in the last two decades has been a
determining factor in progressive reduction in the incidence of acute rejection and the
significant increase in graft survival in the first year after transplantation of
vascularized organs. The polycyclic Tacrolimus is a macrolide first isolated in 1985
by fermenting the juice of the microorganism Streptomyces tsukubaensis, present in
the soil of the city of Tsukuba located in northern Japan This is an
immunosuppressant that inhibits calcineurin phosphatase is a responsible for calcium
dependent transcription of interleukin 2, the main cytokine involved in the immune
response mediated by T lymphocyte This drug acts, thus inhibiting the production of
IL-2, thereby blocking the mechanisms involved in acute cellular rejection. It is the
most currently used immunosuppressive agent in patients undergoing kidney and
liver transplantation and has shown effectiveness in treating some skin diseases
such as atopic dermatitis and psoriasis. The main side effects of this drug are: blood
disorders, kidney toxicity, neurotoxicity, hypertension, hyperlipidemia, oral
abnormalities, diabetes, leukoencephalopathy, opportunistic infections and malignant
gastrointestinal disorders and hypocalcemia. The Tacrolimus must have an
individualized dose according to your dosage of blood, and patients should be
advised to avoid medications that may alter the levels of the immunosuppressant.
The reference method for the therapeutic monitoring of tacrolimus is liquid
chromatography-mass spectrometry although several immunoassays are used for
routine monitoring.