Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 28, 2020; 10(11): 356-364
Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.356
Exploring the safety and efficacy of adding ketoconazole to tacrolimus in pediatric renal transplant immunosuppression
Sindy Méndez, Brooke M Ramay, Angie Aguilar-González, Randall Lou-Meda
Sindy Méndez, Angie Aguilar-González, Randall Lou-Meda, Fundación para el Niño Enfermo Renal - FUNDANIER, Hospital Roosevelt Guatemala, Guatemala 01010, Guatemala
Brooke M Ramay, Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, Guatemala 01015, Guatemala
Author contributions: Méndez S, Ramay BM, Aguilar-González A and Lou-Meda R conceptualized and designed the study, acquired, analyzed and interpreted data, supported drafting the article and making critical revisions; all the authors have given final approval of the version of the article to be published.
Institutional review board statement: The Research Ethics Committee from the Faculty of Humanities and Science, at the Universidad del Valle de Guatemala reviewed and approved the study protocol and all study documents (QF-010-febrero2015).
Informed consent statement: Researchers did not collect any personal identifiers to carry out this retrospective chart review. Informed consent was waived and approved by the ethics committee.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brooke M Ramay, BSc, PharmD, Pharmacist, Professor, Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala 01015, Guatemala. bramay@uvg.edu.gt
Received: May 15, 2020
Peer-review started: May 15, 2020
First decision: May 24, 2020
Revised: June 18, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 28, 2020
Processing time: 191 Days and 21.2 Hours
Core Tip

Core Tip: In the most advanced stages of chronic kidney disease, transplantation improves patient survival. However, in low to middle income countries, transplantation is not feasible due to the high cost associated with transplant maintenance. Expenditures may be mitigated by pharmacokinetically boosting transplant medications. We present the addition of ketoconazole to post transplant regimens to boost therapeutic levels of tacrolimus, thus maintaining efficacy while reducing total daily doses. We found that therapeutic levels of tacrolimus were preserved during the study period, patients demonstrated an improvement in estimated glomerular filtration rate and a 21% reduction in medication cost.