Effectiveness of Sirolimus in Combination with Cyclosporine against Chronic Rejection in a Pediatric Liver Transplant Patient
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- Shinke Haruka
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Hashi Sachiyo
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Kinoshita Risa
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Taniguchi Risa
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Sugimoto Mitsuhiro
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Matsubara Kazuo
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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- Ogawa Eri
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Sonoda Mari
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Takada Narito
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Yoshizawa Atsushi
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Ogawa Kohei
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Okamoto Shinya
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Uemoto Shinji
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
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- Masuda Satohiro
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
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The patient is a 3-year-old boy who received living-donor liver transplantation (LDLT) for hepatoblastoma, with his mother as the donor. Oral tacrolimus was started at a dose of 0.3 mg every 12 h from day 1, with the dosage adjusted on the basis of trough concentrations. The levels of aspartate aminotransferase (AST), alanine transferase (ALT), and total bilirubin (T-bil) were 110 U/L, 182 U/L, and 12.6 mg/dL, respectively, when chronic rejection (CR) was pathologically diagnosed. Then, sirolimus at a dose of 1.0 mg/d was added to the tacrolimus-based regimen. The T-bil level rapidly decreased to 5.4 mg/dL, without changes in AST and ALT. Because the intracellular receptor of sirolimus and tacrolimus is FK506-binding protein 12, we switched tacrolimus to cyclosporine at a dose of 60 mg/d to avoid competitive inhibition between these 2 drugs. The target trough concentration of sirolimus and cyclosporine was set to around 15 ng/mL and 180 ng/mL, respectively. The concentration/dose ratio of sirolimus was significantly correlated with the blood cyclosporine level (r=0.5293, p<0.05), suggesting the pharmacokinetic interaction between these 2 drugs. Thereafter, the levels of AST and ALT as well as the T-bil were successfully decreased to 73 U/L, 83 U/L, and 3.0 mg/dL, respectively. These results suggest that sirolimus therapy in combination with cyclosporine may be an effective treatment against CR after liver transplantation.
収録刊行物
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- Biological & Pharmaceutical Bulletin
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Biological & Pharmaceutical Bulletin 36 (7), 1221-1225, 2013
公益社団法人 日本薬学会
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詳細情報 詳細情報について
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- CRID
- 1390282679609243520
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- NII論文ID
- 130003361486
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- NII書誌ID
- AA10885497
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- COI
- 1:STN:280:DC%2BC3snktVWqsQ%3D%3D
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- ISSN
- 13475215
- 09186158
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- HANDLE
- 2433/178726
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- NDL書誌ID
- 024644845
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- PubMed
- 23676788
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- 本文言語コード
- en
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- データソース種別
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- JaLC
- IRDB
- NDL
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