Administering immunosuppressive drugs by feeding tube in kidney transplant recipients: Practical guide for nephrologists.

Abstract

Kidney transplant recipients require immunosuppressive maintenance therapy to avoid acute rejection and the loss of the kidney graft. Most of the drugs, except belatacept, are solid oral medications which pose difficulty for patients who need enteral feeding tube. Appropriate drug delivery through enteral feeding tubes requires consideration of the tube placement site, drug formulation and compatibility. Occupational safety of handling drugs should also be addressed. We reviewed the available literature to ensure comprehensive inclusion of evidence to guide enteral feeding tube administration of immunosuppressive therapy for transplant recipients. An in-depth framework is suggested that prioritizes patients' oral administration of immunosuppressive medication, followed by intravenous administration as short-term measures, and enteral feeding tube administration only when this is the sole route feasible. A practical guide is hereby provided when the transplant team has to resort to enteral feeding tube for drug administration.