Study of Cyclosporine Level at 2 Hours after Administration in Preoperative Kidney Transplant Recipients for Prediction of Postoperative Optimal Cyclosporine Dose
Narin Sukhavasharin MD*, Kearkiat Praditpornsilpa MD*, Yingyos Avihingsanon MD*, Pawinee Kuoatawintu MD**, Ratchanee O-Charoen MD**, Talerngsak Kansanabuch MD*, Kriang Tungsanga MD*, Somchai Eiam-Ong MD*
Affiliation : * Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Hospital ** National Blood Center, Thai Red Cross Society
Objective : Absorption profiling of cyclosporine is a current concept of drug monitoring. A single blood
concentration measurement 2 hours after cyclosporine administration (C2) has been shown to be a good
predictor of drug exposure and clinical outcome. The recommendation states that achieving the recommended
target level of 1700 (cid:31) 340 ng/ml within 3-5 days after renal transplantation is associated with a lower rate of
acute rejection and nephrotoxicity. The high variation of pharmacokinetic profile and short limited time
during early post-transplantation period make it hard to adjust the cyclosporine dose that can reach that
target level on time. The present study was designed to be a method to predict the optimal pre-transplant CsA
dose.
Materials and Methods : Eleven living-related kidney transplant recipients were recruited to receive cyclosporine
and were monitored for C2 concentration during the 2 weeks before operation by the designed method. The
pre-transplant empirical dose of 3.5 mg/kg/dose every 12 hours were assigned to all patients. The first pre-
dicted dose was estimated by using C2 concentration of 1,700 ng/mL. The first predicted dose was prescribed
to the patients. The second predicted dose was estimated by using C2 concentration of the first predicted dose.
All patients received the average of the first and the second predicted doses of cyclosporine within 12-24 hrs
before transplantation and until the 3rd day after transplantation.
Results : Nine out of 11 patients (81.81%) reached the target C2 level on the 3rd day after transplantation
without any serious side effect and complications. The most common side effect was nausea and a flushing
sensation that usually abated with a later dose after transplantation.
Conclusion : The early postoperative optimal cyclosporine dose can be effectively predicted by pre-transplant
C2 measurement as conducted in the present study.
Keywords : Cyclosporine level, Kidney transplantation
