Pharmacokinetic and pharmacodynamic considerations of antibiotics and antifungals in liver transplantation recipients

Document Type

Article

Publication Date

1-1-2023

Publication Title

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

Abstract

The liver plays a major role in drug metabolism. Liver transplantation impacts the intrinsic metabolic capability and extrahepatic mechanisms of drug disposition and elimination. Different levels of inflammation and oxidative stress during transplantation, the process of liver regeneration, and the characteristics of the graft alter the amount of functional hepatocytes and activity of liver enzymes. Binding of drugs to plasma proteins is affected by the hyperbilirubinemia status and abnormal synthesis of albumin and alpha-1-acid glycoproteins. Postoperative intensive care complications such as biliary, circulatory, and cardiac also impact drug distribution. Renally eliminated antimicrobials commonly present reduced clearance due to hepatorenal syndrome and the use of nephrotoxic immunosuppressants. In addition, liver transplantation recipients are particularly susceptible to multidrug-resistant infections due to frequent manipulation, multiple hospitalizations, invasive devices, and frequent use of empiric broad-spectrum therapy. The selection of appropriate anti-infective therapy must consider the pathophysiological changes after transplantation that impact the pharmacokinetics and pharmacodynamics of antibiotics and antifungal drugs.

Medical Subject Headings

Humans; Antifungal Agents; Anti-Bacterial Agents; Liver Transplantation; Liver

PubMed ID

35643926

Volume

29

Issue

1

First Page

91

Last Page

102

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