Article written by Dr. Ly Thi Thanh Ha – Share99 High-tech Center
The identification of the CYP3A5 genotype in kidney transplant patients is important in determining the starting dose of Tacrolimus for the patient, in addition to shortening the time to reach the base concentration in the blood, but also reducing the risk of transplant discharge.
1. What is a kidney transplant?
A kidney transplant is the taking of a healthy person's kidney or a good kidney of a person who has died brain to transplant into the abdomen (actually out of the abdomen because the kidney transplanted on the peri membrane).
The source of the kidneys for transplantation can be from the living for the kidneys or from people who have suffered brain death. Whether or not the brain dead get a kidney for a transplant is decided by the hospital's professional councils. Currently in our country most patients receive kidney transplants from people of the same blood.
2. The role of genetic testing in regulating the dose of immunosuppressive drugs that treat patients after a kidney transplant
The results of post-transplant patients in general and kidney transplants in particular depend greatly on the regimen of use of immunosuppressive drugs. One of the commonly used immunosuppressive drugs is Tacrolimus. Tacrolimus conversion occurs in the liver and intestines through the action of the enzymes CYP3A4 and CYP3A5.
In particular, CYP3A5 is a catalyst that is more effective at converting Tacrolimus than CYP3A4. The drug's ability to convert the enzyme CYP3A5 depends on polynthings on the CYP3A5 gene. Polynthings on this gene are largely mononucleotide mutations and can occur in multiple locations on the gene. To date, there are 9 single nucleotide (polymorphism) transformations on the CYP3A5 gene found, and these alleles are deticed from *1 to *9, which form 25 types of polymorphic transformations on the CYP3A5 gene. Identifying the allele of these variations with a Gene test has a huge effect on the treatment regimen for post-transplant patients.
Depending on the type of allele the first dose of immunosuppressive drugs will be adjusted so that the concentration of the drug will reach the required concentration maintained in the blood as quickly as possible, reducing the risk of transplantation and not toxic to the patient. The initial drug concentration can be increased by 1.5-2 times compared to normal concentrations if the allele type carries an increase in the level of immunosuppressive drug conversion.
According to published studies, the frequency of CYP 3A5 genotypes varies between ethnicities. With CYP3A5*1/*1 the most in black and Asian races, CYP3A5*3/*3 is most commonly found among whites in Europe and the UnitedStates.
Thus, the identification of the CYP3A5 genotype in kidney transplant patients is important in determining the starting dose of Tacrolimus for the patient, in addition to shortening the time to reach the bottom concentration in the blood, but also reducing the risk of transplant discharge.
Currently, this test is being carried out at the Medical Genetics Department, High-tech Center. The time to return the result after 3-7 days.
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