Tacrolimus trough levels before, during and after jejunostomy in a liver transplant patient: a case report

Effect of Jejunal Administration on Tacrolimus Trough Concentrations in a Pediatric Liver Transplant Recipient

Maintenance immunosuppression regimens containing calcineurin inhibitors, specifically tacrolimus, are standard of care for rejection prevention in pediatric liver transplantation. Challenges with tacrolimus administration are common with pediatric patients, and guidance for non-oral, enteral administration of tacrolimus is limited. We report the case of an 11-year-old male orthotopic liver transplant recipient with a history of malnutrition requiring a jejunostomy tube (J-tube) for enteral nutrition and medication administration post-transplantation. Tacrolimus was initially given orally, and then transitioned to J-tube administration for 10 days. Tacrolimus trough concentrations declined significantly following conversion to J-tube administration and remained subtherapeutic despite a 3-fold dose increase. Once transitioned back to the oral route, trough concentrations became supratherapeutic requiring dose reductions until goal concentrations were achieved. This case demonstrates reduced bioavailability and need for increased dosing, when tacrolimus is administered through a J-tube.

Modigraf administration through jejunostomy in liver transplant recipient: case report

We report our experience with a 61-year-old patient with alcoholic and hepatitis C cirrhosis who underwent liver transplantation. On the 3rd postoperative day he presented a mediastinitis secondary to esophageal perforation produced by a Linton tube. An esophagectomy with jejunostomy was performed. Tacrolimus granules for oral suspension (Modigraf) were administered through the jejunostomy. This case report highlights the use of Modigraf and the absence of secondary effects. We observed biochemical parameters during the jejunostomy period. We discuss the administration strategy applied and whether tacrolimus granules for oral suspension by jejunostomy affect the bioavailability and its side effects.