J Korean Soc Transplant.  2016 Sep;30(3):138-142. 10.4285/jkstn.2016.30.3.138.

Falsely Elevated Tacrolimus Concentrations Using Chemiluminescence Microparticle Immunoassay in Kidney Transplant Patient

• Yang D
• Song SA
• Jun KR
• Rim H
• Lee W

• KMID: 2354638
• DOI: http://doi.org/10.4285/jkstn.2016.30.3.138

Abstract

Tacrolimus is one of the effective immunosuppressive drugs used after an organ transplant procedure. However, due to its narrow therapeutic range, its usefulness in preventing transplant rejection and minimizing nephrotoxicity is dependent on the monitoring of whole blood trough levels of tacrolimus. A 49-year-old kidney transplant recipient presenting with cough and general weakness was admitted to the hospital. Due to the patient's deeply compromised clinical condition, an immunosuppressive therapy was discontinued. Tacrolimus concentrations in the patient's whole blood samples were measured, using an automated chemiluminescent microparticle immunoassay (CMIA) instrument. Interference was suspected because tacrolimus concentrations after the discontinuation of tacrolimus dose were 20.9 and 18.2 ng/mL at day 2 and 3, respectively. Tacrolimus concentrations were 11.1 and 12.6 ng/mL, respectively, when re-tested using an antibody-conjugated magnetic immunoassay (ACMIA). We evaluated the relationship between the CMIA and ACMIA results, and calculated the expected values from the regression equation. Residuals were -8.4 and -4 ng/mL, respectively. There have been several cases with false detection of elevated tacrolimus concentrations using ACMIA; however, such falsely detected elevations using CMIA have rarely been reported. When unexpectedly high concentrations of tacrolimus are detected by CMIA in transplant patients, an immediate re-test using another technique might be necessary to rule out falsely elevated results.

Keyword

Tacrolimus; Chemiluminescence microparticle immunoassay; Antibody conjugated magnetic immunoassay; Kidney transplantation

MeSH Terms

Cough
Graft Rejection
Humans
Immunoassay*
Kidney Transplantation
Kidney*
Luminescence*
Middle Aged
Tacrolimus*
Transplant Recipients
Transplants
Tacrolimus

Figure

• 

  Fig. 1. Clinical course showing hemoglobin (Hb), blood urea nitrogen (BUN), tacrolimus concentration (left y axis), and serum creatinine level (right y axis). Patient took last dose of tacrolimus on day 5 and was withheld on day 6. Abbreviations: CMIA, chemiluminescence microparticle immunoassay; ACMIA, antibody conjugated magnetic immunoassay.

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