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The failure of organs such as the kidneys or the liver occurs when they lose their ability to perform their physiological functions, and this creates a potential threat for both the patient's quality of life and survival. The kidneys perform several physiological functions, from filtering the blood to remove metabolic waste, to maintaining an electrolyte balance and even the regulation of red blood cell production through the erythropoietin hormone. Renal failure is usually quantified through lab tests, from mild (grades 1-2) to severe and advanced or terminal kidney disease (grade 5). The latter has only two possible therapeutic approaches, kidney replacement treatment (dialysis) or transplant. The former is a palliative therapy with a machine performing the kidney's filtration function. Although effective in most cases, this approach requires the patient to go to hospital 3 times a week for long dialysis sessions. In transplantation, however, a new, functioning kidney (graft) is implanted by surgery to recover the lost function. In patients with liver failure the situation is even more complicated. A functioning liver is absolutely essential for survival and there is not yet a palliative therapy like dialysis for patients with severe liver failure. Therefore, the only therapeutic approach is transplantation. Unlike kidney transplants, the original liver is removed during the surgical procedure and then replaced with the new organ.

 

Two very important constraints for transplants are organ availability, which continues to be much lower than the demand, and the biological and immunologic compatibility of donor and recipient. Physiologically, the immune system protects the body from external pathogens, recognising what belongs to the host (the patient) and what does not (external). Although critical in the defence of a healthy individual, in a transplant patient who received a graft from a donor, the immune system does not recognise it and therefore attacks and rejects the transplanted organ. The current standard of treatment to prevent rejection is a combination of immunosuppressant drugs that aims to reduce the reactivity of the immune system to prevent rejection, while at the same time trying not to do so too much in order to not expose the individual to an elevated risk of opportunistic infections. The treatment is administered for the rest of the organ's life. The average survival of a transplanted kidney is approximately 10 years, and slightly less for a liver. The standard of care used today is based on a triple combination of immunosuppressants, of which tacrolimus is the most important.1,2

 

Envarsus is a new tacrolimus formulation for single daily administration that ensures prolonged release, enabling better patient management after kidney or liver transplantation,. In transplanted patients, well-controlled immune suppression is key for reducing risks and side effects, and to ensure the longest possible survival of the transplanted organ. Especially when we use drugs with a narrow therapeutic margin such as tacrolimus. Envarsus requires a 30% smaller dose to attain the same blood levels. Moreover, considering the patient's convenience, Envarsus is administered just once a day, improving adherence.1,3,4

 

References:

  • 1.Grinyó JM, Petruzzelli S.Once-daily LCP-Tacro MeltDose tacrolimus for the prophylaxis of organ rejection in kidney and liver transplantations. Expert Rev. Clin. Immunol. 10(12),1567–1579 (2014).
  • 2.Halloran PF et al. Immunosuppressive drugs for kidney Transplantation. N Engl J Med 2004; 351:2715-2719.
  • 3.Garnock-Jones KP. Tacrolimus Prolonged Release (Envarsus®): A Review of Its Use in Kidney and Liver Transplant Recipients. Drugs. Published online: 23 january 2015.
  • 4.DOI 10.1007/s40265-015-0349-2.
  • 5.Ficha Tecnica Envarsus.

 

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