Targeted blood levels of cyclosporin for cardiac transplantation
Griffith, B.P.; Hardesty, R.L.; Trento, A.; Lee, A.; Bahnson, H.T.
Journal of Thoracic and Cardiovascular Surgery 88(6): 952-957
1984
ISSN/ISBN: 0022-5223 PMID: 6389991 Document Number: 237018
Forty-nine patients have undergone cardiac transplantation since July, 1982; all were treated with maintenance cyclosporine and low-dose prednisone, 15-20 mg. Cyclosporine dose was targeted to a whole-blood level of 1000 ng/ml as measured by radioimmune assay. The actuarial survival rate in this group of patients was 79% at 12 mo. and 71% at 21 mo. Histologic rejection occurred at all blood levels of cyclosporine, as did significant nephrotoxicity. The hepatic toxicity encountered was more a clinical nuisane than significant problem. The administered dose of cyclosporine required to reach a target of 1000 ng/ml varied from 2-30 mg/kg per day. The average perioperative and late serum creatinine levels were 1.2 and 1.49 mg/dl and occurred with cyclosporine levels of 1078 and 1068 ng/ml, respectively. Late cyclosporine toxicity persisted despite reduction in the dose of cyclosporine below the targeted 1000 ng/ml. Some method of blood level monitoring is necessary in patients receiving cyclosporine immune suppression to assure adequacy of the administered dose. The 1000 ng/ml target provides adequate immune suppression. Significant nephrotoxicity is not correlated with the blood level measured.