الفهرس 
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Abstract
Since the introduction of tacrolimus, there has been significant improvement in the results of solid organ transplantation. However the deleterious effects of tacrolimus and its high cost stand as a major disadvantage for long term use of the drug. ?Metabolism of tacrolimus occurs almost exclusively in liver via hepatic cytochrome P450 microsomal enzymes. Ketoconazole, which is a broad spectrum antifungal drug, has been shown to inhibit the cytochrome P450 enzyme system resulting in marked elevation in blood level of tacrolimus when both drugs are administrated concomitantly. ?The objective of this work was to study the results of the concomitant administration of ketoconazole and tacrolimus in a prospective randomized design. The evaluation included study of the safety of the combination and its impact on the patient and graft outcome. Moreover, the financial impact of this new combination was studied . ?The material of this work included 70 tacrolimustreated kidney transplant recipients who were selected from the pool of kidney transplant patients in the Urology and Nephrology Center, Mansoura university according to standardized inclusion criteria. Patients were randomly divided into two equal groups with addition of keto to group I (keto group). group II was considered as control group. All patients were subjected to prospective evaluation for 6 months. ?In this study, we observed that addition of keto has resulted in significant reduction of the dose of tacrolimus (up to 58.7%) compared with control group (9.32%). At the end of the study, there was highly significant reduction in overall tacrolimus cost among ketotreated patients (56.9%) in comparison with control group (8.4%). Total yearly cost saving in our ketotreated patients (35 patients) was 666467.9 Egyptian pounds. In general, ketoconazoletreated patients showed good tolerance to the drug. None of ketoconazole side effects was noticed and none of the patients stopped the drug at any time during the study. Furthermore, we observed that administration of ketoconazole by tacrolimustreated patients resulted in significant improvement in graft function, fungal skin infection as well as significant reduction in frequency of gastrointestinal episodes and hospitalization. Additionally, it reduced frequency of acute rejection episodes and hypertension. ?In conclusion, concomitant ketoconazoletacrolimus administration in kidney transplant recipients resulted in outstanding cost reduction. This combination is safe and has good impact on the patient and graft outcome.