Reduced Elimination of Cyclosporine A in Elderly (&gt;65 Years) Kidney Transplant Recipients

Falck, Pål; Åsberg, Anders; Byberg, Karen-Therese; Bremer, Sara; Bergan, Stein; Reubsaet, Léon; Midtvedt, Karsten

doi:10.1097/tp.0b013e31818aa4b6

Cited by 51 publications

(35 citation statements)

References 25 publications

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“…Agerelated decreased renal clearance of cyclosporine has been demonstrated in elderly kidney transplant recipients. 48 Hypertension, renal dysfunction, and multiple drug interactions are the major concerns when treating a patient with cyclosporine. 49 Although cyclosporine trough level monitoring is generally not used when monitoring patients with psoriasis, it may be indicated when cyclosporine is used long term at doses greater than 3 mg/kg daily 50 and could also be considered for the elderly.…”

Section: Traditional Systemicsmentioning

confidence: 99%

Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

Grozdev

Voorhees

Gottlieb

et al. 2011

Journal of the American Academy of Dermatology

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Section: Traditional Systemicsmentioning

confidence: 99%

Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

Grozdev

Voorhees

Gottlieb

et al. 2011

Journal of the American Academy of Dermatology

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“…54 A study of cyclosporine in the elderly (>65 years) demonstrated higher cyclosporine concentrations within T-cells. 56 Moreover, CNI elimination was compromised with increasing age.…”

Section: Introductionmentioning

confidence: 99%

A Rationale for Age-Adapted Immunosuppression in Organ Transplantation

et al. 2015

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Demographic changes are associated with a steady increase of older patients with end-stage organ failure in need for transplantation. As a result, the majority of transplant recipients are currently older >50 years and organs from elderly donors are more frequently utilized. Nevertheless, the benefit of transplantation in older patients is well recognized whereas the most frequent causes of death among older recipients are potentially linked to side effects of their immunosuppressants. Immunosenescence is a physiological part of aging linked to higher rates of diabetes, bacterial infections and malignancies representing the major causes of death in older patients. These age-related changes impact older transplant candidates and may have significant implications for an age-adapted immunosuppression. For instance, immunosenescence is linked to lower rates of acute rejections in older recipients while the engraftment of older organs has been associated with higher rejection rates. Moreover, new-onset diabetes mellitus following transplantation is more frequent in the elderly, potentially related to corticosteroids, calcineurin inhibitors and mTOR inhibitors. This review presents current knowledge for an age-adapted immunosuppression based on both, experimental and clinical studies in and beyond transplantation. Recommendations of maintenance and induction therapy may help to improve graft function and to design future clinical trials in the elderly.

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“…Most available pharmacokinetic data in the elderly do not reveal any major differences from the drug disposition detected in younger individuals [54]. A more recent pharmacokinetic study in elderly kidney transplant patients has, however, demonstrated that the clearance of cyclosporine decreased with increasing age and that old patients had a significantly larger proportion of the whole blood cyclosporine concentration located in T lymphocytes [55]. Therefore, selection of the cyclosporine dose for an older patient should be made with caution and it should be started at the lowest limit of the therapeutic range.…”

Section: Alternative Treatmentsmentioning

confidence: 95%

Management of Chronic Spontaneous Urticaria in the Elderly

et al. 2015

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The guidelines for the management of urticaria in adults and children have been revised and updated recently. However, there are few data in the literature concerning several aspects of this disease in the elderly (e.g., epidemiology, etiopathogenesis, clinical aspects, association with co-morbidities, efficacy and safety profiles of treatments, and management strategies). This is an obvious deficiency in the data, as this disease causes a deterioration in quality of life, affecting the quality of sleep, everyday life habits and activities, and inducing severe disability. Chronic spontaneous urticaria (CSU) can also be associated with internal, infectious, autoimmune, or neoplastic diseases. It is therefore necessary to pay particular attention to these clinical issues through appropriate clinical examinations. At the same time, the specific features of medications used to treat CSU in the elderly should be carefully evaluated, as its pharmacological treatment raises a number of problems related both to the clinical condition of the patient and to concomitant diseases, as well as to the polypharmacotherapy, which is common in older subjects and may cause safety problems because of the drug interactions. Non-sedating new-generation antihistamines are the mainstay treatment of CSU for the elderly. The efficacy and safety of alternative treatment options have not been assessed in the geriatric population with CSU; corticosteroids and cyclosporine (ciclosporin) should be used by this population with extreme caution. Similarly, there are no data regarding the actual safety profile of the new-generation antihistamines at higher doses than those recommended in elderly patients.

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Reduced Elimination of Cyclosporine A in Elderly (>65 Years) Kidney Transplant Recipients

Cited by 51 publications

References 25 publications

Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

A Rationale for Age-Adapted Immunosuppression in Organ Transplantation

Management of Chronic Spontaneous Urticaria in the Elderly

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