■钙调磷酸酶抑制剂,包括他克莫司,仍然是肾移植后免疫抑制治疗的基石。然而,治疗窗口狭窄,过量会出现肾毒性副作用,而同种免疫和移植物排斥的风险随着剂量不足而增加。液相色谱-串联质谱(LC-MS/MS)允许定量来自患者的生物样品中的他克莫司。这项研究调查了定量肾移植(KT)接受者头皮头发中他克莫司的可行性,并将头发他克莫司浓度与他克莫司剂量和血谷水平相关联。目的是为KT接受者的头发他克莫司药物监测提供原理证明。
■2021年9月9日至2021年12月4日的单中心前瞻性研究,包括他克莫司的KT接受者。未成年人,患有活动性皮肤或头发疾病的患者,头皮毛发短于4厘米的患者被排除在参与之外。从患者的后顶点收集头皮毛发,切成段,LC-MS/MS分析他克莫司患者填写了有关头发治疗和洗涤习惯的问卷。并行,在全血中测量他克莫司谷水平,并与他克莫司浓度相关。
■总共,包括39名同意的KT接受者,在53次访问时收集了头发样本。在暴露于药物的患者的98%的头发样本中检测到他克莫司。他克莫司头发水平和全血波谷水平与0.42的β系数相关(95%CI:-0.22-1.1,p=n.s.)。年龄和黑发影响头发他克莫司测量,而不同的他克莫司配方(速释与延长释放),洗发,和永久着色没有。患者亚组的纵向测量表明,长期测量他克莫司水平是可行的。
■在头发中测量他克莫司是监测KT患者药物暴露的潜在可靠方法。随着时间的推移,快速的洗入效果和一致的浓度表明他克莫司被掺入头发基质中,允许在最近的曝光和曝光历史的分析时间分辨率。这种方法提供了一个简单和低风险的替代常规血液采样,通过自我收集头发样本,避免患者频繁就诊。
UNASSIGNED: Calcineurin inhibitors, including tacrolimus, remain a cornerstone of immunosuppressive therapy after kidney transplantation. However, the therapeutic window is narrow, and nephrotoxic side effects occur with overdose, while the risk of alloimmunization and graft rejection increases with underdose. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) allows quantification of tacrolimus in biological samples from patients. This study investigates the feasibility of quantifying tacrolimus in scalp hair from kidney transplant (KT) recipients and correlates hair tacrolimus concentrations with tacrolimus dosage and blood trough levels. The aim was to provide proof-of-principle for hair tacrolimus drug monitoring in KT recipients.
UNASSIGNED: Single-center prospective study between September 9, 2021 and December 4, 2021, including KT recipients under tacrolimus. Minors, patients with active skin or hair diseases, and patients with scalp hair shorter than 4 cm were excluded from participation. Scalp hair was collected from the posterior vertex of patients, cut into segments, and analyzed for tacrolimus by LC-MS/MS. Patients filled out a questionnaire on hair treatments and washing habits. In parallel, tacrolimus trough levels were measured in whole blood and correlated with hair tacrolimus concentrations.
UNASSIGNED: In total, 39 consenting KT recipients were included, and hair samples were collected at 53 visits. Tacrolimus was detected in 98% of hair samples from patients exposed to the drug. Tacrolimus hair levels and whole blood trough levels were correlated with a beta coefficient of 0.42 (95% CI: -0.22-1.1, p = n.s.). Age and dark hair affected hair tacrolimus measurements, while different tacrolimus formulations (immediate release vs. extended release), hair washes, and permanent coloring did not. Longitudinal measurements in a subgroup of patients indicate that long-term measurement of hair tacrolimus levels is feasible.
UNASSIGNED: Measuring tacrolimus in hair is a potentially reliable method to monitor drug exposure in KT patients. Rapid wash-in effects and consistent concentrations over time indicate that tacrolimus is incorporated into the hair matrix, allowing temporal resolution in the analysis of recent exposure and exposure history. This method provides a simple and low-risk alternative to regular blood sampling, sparing patients from frequent hospital visits through the self-collection of hair samples.