O uso do tacrolimo no transplante hepático

Abstract

The first attempt in human liver transplant was performed in the United States, in Denver, Colorado, by Thomas Starzl in 1963. The onset of clinical immunosuppression in 60 years has contributed significantly to the development of transplant programs. The use of glucocorticoids associated with azathioprine remained as the main immunosuppressant drugs until the early '80s, when cyclosporine was introduced in the U.S. market. From 90 years of other immunosuppressive agents were marketed, including tacrolimus. The widespread use of new immunosuppressive drugs in the last two decades has been a determining factor in progressive reduction in the incidence of acute rejection and the significant increase in graft survival in the first year after transplantation of vascularized organs. The polycyclic Tacrolimus is a macrolide first isolated in 1985 by fermenting the juice of the microorganism Streptomyces tsukubaensis, present in the soil of the city of Tsukuba located in northern Japan This is an immunosuppressant that inhibits calcineurin phosphatase is a responsible for calcium dependent transcription of interleukin 2, the main cytokine involved in the immune response mediated by T lymphocyte This drug acts, thus inhibiting the production of IL-2, thereby blocking the mechanisms involved in acute cellular rejection. It is the most currently used immunosuppressive agent in patients undergoing kidney and liver transplantation and has shown effectiveness in treating some skin diseases such as atopic dermatitis and psoriasis. The main side effects of this drug are: blood disorders, kidney toxicity, neurotoxicity, hypertension, hyperlipidemia, oral abnormalities, diabetes, leukoencephalopathy, opportunistic infections and malignant gastrointestinal disorders and hypocalcemia. The Tacrolimus must have an individualized dose according to your dosage of blood, and patients should be advised to avoid medications that may alter the levels of the immunosuppressant. The reference method for the therapeutic monitoring of tacrolimus is liquid chromatography-mass spectrometry although several immunoassays are used for routine monitoring.