Effect of cyclosporin pharmacokinetics on renal allograft outcome in African‐Americans

Abstract

African-Americans (A-As) experience inferior outcome after transplantation compared with other ethnic groups. Bioavailability of cyclosporin (CsA) has been implicated as a possible contributing factor. This paper describes the outcome of 32 A-A recipients of de novo renal allograft who received CsA-based triple immunotherapy according to individual pharmacokinetic profiles. Patients received CsA-microemulsion q 12 h, dosed initially at 3.5 mg/kg (8 am) and 3.0 mg/kg (8 pm). The am and pm doses were independently adjusted to achieve a 12-h area under the concentration-time curve (AUC0-12) of 6600-7200 nghr/mL and morning trough level (C0) of 250-325 ng/mL, respectively. Mean age was 43 +/- 12 yr, 37% (12) female. Mean AUC0-12 in 1 wk, 1, 3, 6, and 12 months were 7810 +/- 1880 nghr/mL, 9057 +/- 2097 nghr/mL, 7674 +/- 1912 nghr/mL, 7132 +/- 2040 nghr/mL, and 6503 +/- 1410 ngl/h with corresponding C0 of 301 +/- 79 ng/mL, 316 +/- 66 ng/mL, 275 +/- 59 ng/mL, 273 +/- 66 ng/mL, and 224 +/- 49 ng/mL, respectively. Acute rejection occurred in two patients (6%) 1 yr after transplantation. Prospective use of CsA pharmocokinetic profiles improves renal allograft outcome in A-As.

Cyclosporine Therapeutic Monitoring With CMAX in Kidney Transplant Recipients: Impact of Schistosomal Infection

“…Many investigators claim that C 2 level is the most appropriate method for post‐transplantation monitoring of CsA, reducing the incidence of acute rejection episodes 1, 2. This study demonstrates that C 2 and not C 0 shows a significant relationship with daily dose expressed as mg/kg or expressed as mg/kg/d in non‐schistosomal renal transplant patients in different periods of their post‐transplant management matching with many studies in different races 2, 3, 14. Nevertheless, according to our results using the regression coefficient analysis, this method is not fit for all the recipients in our Egyptian population.…”

“…Numerous analyses have consistently shown that C 2 correlates most closely with the area under the concentration–time curve (AUC 0–4 ) both during the early and later post‐transplantation periods 1. However, most of these data were from white or African American cohorts 2, 3. There is presently a paucity of data and experience on the use of C 2 monitoring in other races and ethnicities.…”

Cyclosporine therapeutic monitoring with CMAX in kidney transplant recipients: racial considerations

“…Many investigators claim that C 2 level is the most appropriate method for post-transplantation monitoring of CsA, reducing the incidence of acute rejection episodes [1,2]. This study demonstrates that is that C 2 and not C 0 shows a significant relationship with daily dose expressed as mg/kg or expressed as mg/kg/day in non-schistosomal renal transplant patients in different periods of their post-transplant management matching with many studies in different races [2,3,15]. Nevertheless, according to our results using the regression coefficient analysis with this method is not fit for all the recipients in our Egyptian population.…”

A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures

“…Aurori et al[39] conducted a retrospective comparative study on 208 patients and found that there was no significant difference in the incidence of pseudarthrosis between allograft and autograft patients between 10 and 17 years old on radiographs or CT scan. Another study by Betz et al[40] on 91 patients found that when adolescents underwent spinal fusion surgery without the addition of any material had a 100 % fusion rate at a minimum of 2-year follow-up. This is likely due to the large volume of local autograft bone harvested and also the ability of children and adolescents to heal and create a robust fusion mass.…”