Recovery of CYP3A Phenotype after Kidney Transplantation

Drug Metab Dispos. 2017 Dec;45(12):1260-1265. doi: 10.1124/dmd.117.078030. Epub 2017 Sep 19.


End-stage renal disease impairs drug metabolism via cytochrome P450 CYP3A; however, it is unclear whether CYP3A activity recovers after kidney transplantation. Therefore, the aim of this study was to evaluate the change in CYP3A activity measured as 4β-hydroxycholesterol (4βOHC) concentration after kidney transplantation. In total, data from 58 renal transplant recipients with 550 prospective 4βOHC measurements were included in the study. One sample per patient was collected before transplantation, and 2-12 samples per patient were collected 1-82 days after transplantation. The measured pretransplant 4βOHC concentrations ranged by >7-fold, with a median value of 22.8 ng/ml. Linear mixed-model analysis identified a 0.16-ng/ml increase in 4βOHC concentration per day after transplantation (P < 0.001), indicating a regain in CYP3A activity. Increasing estimated glomerular filtration rate after transplantation was associated with increasing 4βOHC concentration (P < 0.001), supporting that CYP3A activity increases with recovering uremia. In conclusion, this study indicates that CYP3A activity is regained subsequent to kidney transplantation.

MeSH terms

  • Adult
  • Aged
  • Creatinine / blood
  • Cytochrome P-450 CYP3A / genetics
  • Cytochrome P-450 CYP3A / metabolism*
  • Female
  • Genotype
  • Glomerular Filtration Rate
  • Humans
  • Hydroxycholesterols / metabolism
  • Kidney Transplantation*
  • Liver / enzymology*
  • Liver / metabolism
  • Male
  • Middle Aged
  • Phenotype
  • Prospective Studies
  • Uremia / metabolism
  • Uremia / surgery
  • Young Adult


  • Hydroxycholesterols
  • Creatinine
  • CYP3A protein, human
  • CYP3A5 protein, human
  • Cytochrome P-450 CYP3A
  • CYP3A4 protein, human