Fig. 2.
Three illustrative individual whole-blood concentration (WBC) profiles showing the administered tacrolimus dose and the individual predicted lines. The therapeutic range for tacrolimus C12 h is indicated by grey bars. UTN7: This patient presented C12 h values below the therapeutic range, despite increasing the dosage. The patient was a heart transplant recipient with shock and circulatory support for 4 days. Gut dysmotility was observed for 3 days. UTN13: In this patient, absorption was rapid and complete, with a short Tmax and a high Cmax. This patient was an uncomplicated non-CF lung transplantation patient. Cardiopulmonary bypass was used during surgery. Hyperdynamic circulation in combination with augmented renal clearance existed for 3 days. Diarrhoea was observed on days 4 and 5. UTN14: This patient was a heart transplant recipient and had severe bleeding during surgery, for which two red blood cell units were administered on day 1. For 5 days, he was supported with ECMO, vasopressors and inotropes because he was in shock. Fluid balance ranged from 1 to 4 litres. No gut dysmotility occurred. Very low C12 h values were measured during days 1 and 2, which would support the idea of low absorption or distribution into the red blood cells. High clearance was observed from day 3 to day 6. High doses were needed to achieve a therapeutic C12 h. CF cystic fibrosis, C12 concentration at 12 h, Cmax maximum C12 concentration, Tmax time to reach Cmax