International E-publication: Publish Projects, Dissertation, Theses, Books, Souvenir, Conference Proceeding with ISBN. 

Therapeutic monitoring and adverse effects of immunosuppressants in kidney transplant patients: a prospective immunoassay study at Batna University Hospital (Algeria)

    , , , ,

Author Affiliations

  • 1University Hospital Centre, Batna, Algeria and Medical faculty, University of Batna, Algeria
  • 2University Hospital Centre, Constantine, Algeria
  • 3University Hospital Centre, Batna, Algeria
  • 4University Hospital Centre, Batna, Algeria and Medical faculty, University of Batna, Algeria
  • 5National Toxicology Centre, Algeirs, Algeria

Int. Res. J. Biological Sci., Volume 15, Issue (1), Pages 1-7, February,10 (2026)

Abstract

The preferred course of treatment for end-stage renal failure is kidney transplantation, but its success depends on efficient and balanced immunosuppression. When taken with mycophenolate mofetil, calcineurin inhibitors (tacrolimus, ciclosporin) show significant pharmacokinetic variability and a high risk of toxicity, necessitating careful therapeutic monitoring. This study aims to assess plasma concentrations and side effects related to these compounds' use in kidney transplant recipients. A prospective, descriptive study was realised at the Benflis Touhami University Hospital in Batna (Algeria) between March 2014 and December 2019. It included 246 patients who had received renal transplantation from living donors ; 210 on tacrolimus and 36 on cyclosporine, all receiving mycopenolic acid (MMF) and corticosteroids, the residual (C₀) and post-dose (C₂) concentrations were mesured by electrochemiluminescence. Kidney function and side effects were assessed over a 12-month period. In patients treated with tacrolimus, mean concentrations decreased from 11.8 ng/mL at the beginning of the transplantto 8.5 ng/mL at the end of the first year after transplantation, with stable renal function. In patients treated with cyclosporine, a gradual increase in creatinine and a decrease in glomerular filtration rate were observed. Adverse skin effects (particularly acne) were significantly more frequent with cyclosporine (36.1%, p < 0.001), while neurological disorders (tremors 15.5%) predominated with tacrolimus. Strong correlations were found between plasma concentrations and renal function parameters, particularly for cyclosporine (r = 0.859 between C₀ and creatinine at 12 months). Therapeutic monitoring using immunological methods is a reliable and effective tool for the individualised monitoring of immunosuppressants in renal transplant patients. Tacrolimus has a better renal tolerance profile, while cyclosporine is more often associated with skin effects. These results highlight the importance of personalised pharmacological monitoring in order to optimise post-transplant care.

References

  1. Collins, A., Foley, R., Chavers, B., Gilbertson, D., Herzog, C., Johansen, K., ... & Agodoa, L. (2014)., US Renal Data System 2013 annual data report., American Journal of Kidney Diseases, 63(1), E1-E460.
  2. Alechinsky-Yildiz, L., Colin, P., Couapel, J. P., De Saint-Aubert, N., Drouin, S., Droupy, S. (2018)., Urologie: Réussir les ECNi. Elsevier Health Sciences.,
  3. Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Yang, C. W. (2013)., Chronic kidney disease: global dimension and perspectives., The lancet, 382(9888), 260-272.
  4. Rekhif, Y. (2021)., Organ donation in Algeria: limitations and prospects., Pan African Medical Journal, 39(1).
  5. Atik, A., Tehir, M., Khemri, D., Bougroura, A., Ramdani, B., Bayahia, R. Benziane, A. (2017)., Kidney transplantation in the Maghreb: current situation and prospects., Néphrologie & Thérapeutique, 13(5), 291.
  6. Jurewicz, W. A. (2003)., Tacrolimus versus ciclosporin immunosuppression: long‐term outcome in renal transplantation., Nephrology Dialysis Transplantation, 18(suppl_1), i7-i11.
  7. Ashraf, H., Solla, P., & Sechi, L. A. (2022)., Current advancement of immunomodulatory drugs as potential pharmacotherapies for autoimmunity based neurological diseases., Pharmaceuticals, 15(9), 1077.
  8. Rodrigo, E., San Segundo, D., Fernández-Fresnedo, G., López-Hoyos, M., Benito, A., Ruiz, J. C.Arias, M. (2016)., Within-patient variability in tacrolimus blood levels predicts kidney graft loss and donor-specific antibody development., Transplantation, 100(11), 2479-2485.
  9. Colombo, M. D., Perego, R., & Bellia, G. (2013)., Cyclosporine associated of nephrotoxicity., Open Journal of Nephrology, 3(03), 168.
  10. Lier, F., Piguet, V., Stoller, R., Desmeules, J., & Dayer, P. (2002)., Therapeutics — neurotoxicity of calcineurin inhibitors and analogues.,  French Journal of Internal Medicine (Médecine et Hygiène), 60(2387), 744–747.
  11. Bencini, P. L., Tarantino, A., Grimalt, R., Ponticellp, C., & Caputo, R. (1995)., Porokeratosis and immunosuppression., British Journal of Dermatology, 132(1), 74-78.
  12. Djoudad, E., Bendifallah, B., Meknassi, D., Boudani, S., Meddahi, M., & Zerdoumi, F. (2021)., Post-renal transplantation diabetes: A retrospective study., Nephrology & Therapeutics, 17(5), 393.
  13. Elouaer, Y., Mars, M., Kammoun, K., Troudi, R., Chaker, H., Chaabouni, Y., … Hmida, M. B. (2018)., Overview of kidney transplantation at CHU Hédi Chaker Sfax: A report of 414 cases., Nephrology & Therapeutics, 14(5), 428.
  14. Heisel, O., Heisel, R., Balshaw, R., & Keown, P. (2004)., New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis., American Journal of Transplantation, 4(4), 583-595.
  15. Mudge, D. W., Atcheson, B. A., Taylor, P. J., Pillans, P. I., & Johnson, D. W. (2004)., Severe toxicity associated with a markedly elevated mycophenolic acid free fraction in a renal transplant recipient., Therapeutic drug monitoring, 26(4), 453-455.
  16. Johnston, A., & Holt, D. W. (1999)., Therapeutic drug monitoring of immunosuppressant drugs., British journal of clinical pharmacology, 47(4), 339.
  17. Vogeser, M., Shipkova, M., Rigo-Bonnin, R., Wallemacq, P., Orth, M., Widmann, M., & Verstraete, A. G. (2014)., Multicenter analytical of automated electrochemiluminescent cyclosporine assay., Therapeutic Drug Monitoring, 36(5), 640–650.
  18. Fung, A. W., Knauer, M. J., Blasutig, I. M., Colantonio, D. A., & Kulasingam, V. (2017)., Evaluation of electrochemiluminescence immunoassays for immunosuppressive drugs on the Roche cobas e411 analyzer., F1000Research, 6, 1832.
  19. Zannad, B., Fatma, L. B., Belkhiria, M., Rafrafi, N., Khedher, R., Jebali, H., Moussa, F. B. (2014)., Overview of renal transplantat at Rabta University Hospital., Nephrology & Therapeutics, 10(5), 408-409.
  20. Yahiaoui, N. (2011)., Therapeutic monitoring of tacrolimus during the three months following transplantation: retrospective study of the 2010 and 2011 renal allograft cohort at Grenoble University Hospital.,
  21. Zahid, S., Elkhayat, S., Serghini, H., Baba, A., Medkouri, G., Chkairi, N., Ramdani, B. (2021)., De novo diabetes after kidney transplantation: risk factors., Revue Marocaine de Néphrologie, 1(2), 128-133.
  22. Raoundi, O., Flayou, K., En, N. F., Shimi, N., Ouzeddoune, N., Benamar, L., ... & Rhou, H. (2015)., Kidney transplantation from living donors: experience of one centre., Nephrology & Therapeutics, 11(5), 416.
  23. Laftavi, M. R., Alnimri, M., Weber-Shrikant, E., Kohli, R., Said, M., Patel, S., & Pankewycz, O. (2011)., Low-dose rabbit antithymocyte globulin versus basiliximab induction therapy in low-risk renal transplant recipients: 8-year follow-up., In Transplantation proceedings, 43(2), 458-461. Elsevier.
  24. Fantini, M. C., Becker, C., Kiesslich, R., & Neurath, M. F. (2006)., Novel small molecules and drugs for immunosuppression., Nature Clinical Practice Gastroenterology & Hepatology, 3(11), 633-644.