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Graft rejection: pharmacogenetic analysis or drug anamnesis?

ABSTRACT:

Aims

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.

SUBMITTER: Pham VV

PROVIDER: S-EPMC2485220 | biostudies-literature | 2008 Jun

REPOSITORIES: biostudies-literature

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Graft rejection: pharmacogenetic analysis or drug anamnesis?

Pham V Vi VV Stichtenoth Dirk O DO Borlak Jürgen J

British journal of clinical pharmacology 20080313 6

<h4>Aims</h4>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.<h4>Methods</h4>Since constant sufficient blood level of tacrolimus and sirolimus had never been achieved, a genetic analysis was carried out to clarify drug metabolism.<h4>Results</h4>The genetic analysis for polymorphisms of cytochrome P450 (CYP) 3A4,5,7 reve ...[more]

PMID: 18341681

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