Graft rejection: pharmacogenetic analysis or drug anamnesis?
OBJECTIVE
A 23-year-old Caucasian woman, with cystic fibrosis, bilateral lung-transplantation and immunosuppressive therapy with prednisolone, tacrolimus and sirolimus, presented with clinical symptoms of a chronic transplant rejection.


METHODS
Since constant sufficient blood level of tacrolimus and sirolimus had never been achieved, a genetic analysis was carried out to clarify drug metabolism.


RESULTS
The genetic analysis for polymorphisms of cytochrome P450 (CYP) 3A4,5,7 revealed no sequence alterations in the CYP 3A4,5,7 gene. Thus, drug intake was scrutinized in detail, disclosing a missing interval between the intake of both immunosuppressive agents. After a correct drug intake the woman's condition ameliorated and the blood levels reached normal range.


CONCLUSIONS
This case report highlights the crucial importance of basic medical skills like an accurate and dainty drug anamnesis before high tech approaches were applied.
Pham
V Vi
VV
Institute of Clinical Pharmacology, Medizinische Hochschule Hannover and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
Stichtenoth
Dirk O
DO
Borlak
Jürgen
J
D000328:Adult; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000139:chemically induced*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000502:physiology*; D008487:Medical History Taking; D010349:Patient Compliance; D010353:Patient Education as Topic; D011239:Prednisolone / Q000627:therapeutic use; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D011239:Prednisolone; D020123:Sirolimus; D016559:Tacrolimus