title: Two-year follow-up of the pharmacokinetics of immunosuppressive drugs in a neonate who underwent heart transplantation.
abstract: The pharmacokinetic properties of immunosuppressive drugs are quite different in newborns than in adults and few studies describe the pharmacokinetics of these drugs in pediatric heart transplant recipients. We report on the two-year follow up of a neonate who underwent heart transplantation for Hypoplastic Left Heart Syndrome on day of life 9. Two different immunosuppressive regimens were used: cyclosporine, azathioprine and prednisone in the early postoperative period, followed by the routine tacrolimus and mycophenolate mofetil combination plus prednisone from post-transplant day 22. Our findings demonstrate marked variability in immunosuppressive pharmacokinetic profiles early post-transplant. Frequent monitoring of drug levels is required to ensure that they remain within the therapeutic range. After the first 2-3 months post-transplant, changes in immunosuppressive drug levels are less marked and correlate more with the administered dosage.
authors.affiliation: Unit of Clinical Pharmacokinetics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. regazzim@smatteo.pv.it
authors.forename: Mario
authors.initials: M
authors.lastname: Regazzi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Perotti
authors.forename: Carlo
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Maria Delfina
authors.initials: MD
authors.lastname: Molinaro
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Tzialla
authors.forename: Rita
authors.initials: R
authors.lastname: Cabano
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: D'Armini
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
mesh_terms: D016572:Cyclosporine / Q000493:pharmacokinetics*; D004359:Drug Therapy, Combination; D016027:Heart Transplantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008657:Metabolic Clearance Rate; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000493:pharmacokinetics*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus