Variable cyclosporine exposure: a risk factor for chronic allograft nephropathy and graft loss?

Transplantation Proceedings
X He, A Johnston

Abstract

Following the introduction of ciclosporine (CsA), the 2-year survival of transplanted kidneys improved from less than 60% to over 80%. Though the introduction of this drug resulted in a marked improvement in graft survival, its use was not without problems. Variable absorption and a narrow therapeutic index resulted in the need for measurements of CsA blood concentrations to tailor the drug dose to maximize therapeutic efficacy while minimizing toxicity. Data were available from the LOTESS study of 4948 transplant patients receiving Neoral with at least 5 years' follow-up. Potential risk factors associated with outcome in renal transplant recipients treated with CsA were explored: the primary outcome variable was graft loss. A stepwise binary logistic regression analysis was used to identify donor, recipient, and treatment variables related to outcome. In the initial analysis, chronic rejection was the only significant predictor of graft loss. The relative risk (RR) of graft loss was 16.9 (95% CI = 13.9-20.4). Further analysis identified four independent risk factors for chronic rejection cadaveric donor (RR, 1.50; 95% CI = 1.05-2.15), older donor (RR, 1.02; 95% CI = 1.01-1.02), younger recipient (RR, 1.02; 95% CI = 1.02-1.03),...Continue Reading

References

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Citations

Oct 4, 2013·European Journal of Hospital Pharmacy. Science and Practice·Atholl Johnston
Sep 16, 2005·Transplant International : Official Journal of the European Society for Organ Transplantation·Kris DenhaerynckSabina De Geest
Jan 14, 2012·Transplant International : Official Journal of the European Society for Organ Transplantation·Joanna Sańko-ResmerDouglas Thorburn
Sep 26, 2006·Immunopharmacology and Immunotoxicology·Christelle El-HaibiAlexander M Abdelnoor
Aug 27, 2005·Transplantation·Eliane M Billaud

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