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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2020  |  Volume : 31  |  Issue : 5  |  Page : 1154-1155
Thiopurine S-methyltransferase Genetic Polymorphism and Its Contribution for Azathioprine-Induced Myelosuppression in Kidney Transplant Recipients: A Summative Analysis


1 Private Academic Consultant, Bangkok, Thailand
2 Department of Community Medicine, Dr. D. Y. Patil University, Pune, Maharashtra, India

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Date of Web Publication21-Nov-2020
 

How to cite this article:
Sookaromdee P, Wiwanitkit V. Thiopurine S-methyltransferase Genetic Polymorphism and Its Contribution for Azathioprine-Induced Myelosuppression in Kidney Transplant Recipients: A Summative Analysis. Saudi J Kidney Dis Transpl 2020;31:1154-5

How to cite this URL:
Sookaromdee P, Wiwanitkit V. Thiopurine S-methyltransferase Genetic Polymorphism and Its Contribution for Azathioprine-Induced Myelosuppression in Kidney Transplant Recipients: A Summative Analysis. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Dec 3];31:1154-5. Available from: https://www.sjkdt.org/text.asp?2020/31/5/1154/301189


To the Editor,

Azathioprine is an immunosuppressant that is generally used after renal transplantation.[1] The possible important adverse effect of azathioprine is myelosuppression. In a recent report from Thailand, the rate of myelosuppression of this drug among renal recipients is equal to 7%.[2] To detoxify this drug, the main required enzyme is thiopurine S-methyltransferase (TPMT). The TPMT is a polymorphic enzyme with many polymorphisms. The effect of TPMT polymorphism on azathioprine-induced myelosuppression in kidney transplant recipients is mentioned in the literature.[3],[4] Here, the author performed a summative analysis to assess the interrelationship between TPMT polymorphism and its contribution for azathioprine-induced myelosuppression in kidney transplant recipients in Thailand, a tropical country in Indochina.

The clinical mathematical model technique is used for the present reappraisal study. The primary data on the TPMT polymorphism frequency distribution[5] and the risk due to different TPMT polymorphisms for azathioprine-induced myelosuppression in kidney transplant recipients in Thailand[2] are used for further modeling calculation. Based on the available primary data, it has been found that the frequency of homozygous wild type of TPMT is equal to 90.5%[3] and the odds ratio for having mutated type comparing to wild type of TPMT is equal to 14.18.[2] First, the odds probability calculation is done in order to transform the odds to risk probability. For homozygous wild type (odds = 1), the transformed probability will be equal to 50%. For non-homozygous wild type, the transformed probability will be equal to 93.41%. Comparing the derived probability rates between non-homozygous wild type and homozygous wild type, the rate of non-homozygous wild type is 1.87 times higher.

To estimate the contributing chance due to different polymorphisms of TPMT, the path probability distribution calculation is done as presented in [Table 1]. Based on the analysis, the chance that a homozygous wild type contributes to azathioprine-induced myelosuppression in kidney transplant recipients is more than that of non-homozygous wild type. This is explainable by a more common frequency of homozygous wild type in general renal recipients. Therefore, close monitoring for possible azathioprine-induced myelosuppression in kidney transplant recipients in patients receiving azathioprine is necessary regardless of TPMT polymorphism determination.
Table 1: Path probability distribution due to different polymorphisms of thiopurine S-methyltransferase.

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Conflict of interest: None declared.



 
   References Top

1.
Ahmed AR, Moy R. Azathioprine. Int J Dermatol 1981;20:461-7.  Back to cited text no. 1
    
2.
Vannaprasaht S, Angsuthum S, Avihingsanon Y, et al. Impact of the heterozygous TPMT*1/ *3C genotype on azathioprine-induced myelosuppression in kidney transplant recipients in Thailand. Clin Ther 2009;31: 1524-33.  Back to cited text no. 2
    
3.
Cabaleiro T, Roman M, Gisbert JP, Abad-Santos F. Utility of assessing thiopurine S-methyltransferase polymorphisms before azathioprine therapy. Curr Drug Metab 2012;13: 1277-93.  Back to cited text no. 3
    
4.
Guillotin V, Galli G, Viallard JF. Usefulness of thiopurine methyltransferase polymorphism study and metabolites measurement for patients treated by azathioprine. Rev Med Interne 2018;39:421-6.  Back to cited text no. 4
    
5.
Srimartpirom S, Tassaneeyakul W, Kukongviriyapan V, Tassaneeyakul W. Thiopurine S-methyltransferase genetic polymorphism in the Thai population. Br J Clin Pharmacol 2004;58:66-70.  Back to cited text no. 5
    

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Correspondence Address:
Pathum Sookaromdee
Private Academic Consultant, Bangkok
Thailand
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DOI: 10.4103/1319-2442.301189

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