The Relationship between the Plasma Level of Cyclosporine-A and Drug Dose in Patients of Kermanshah Kidney Transplantation Center

Abstract

Background: Nowadays the main problem in transplantation is the complexity of host immune system protection against the immunological and destructive reactions of the transplanted organ. High serum level of the immunosuppressive drug may cause toxicity and low serum level leads to the rejection of the transplanted organ. Cyclosporine has been known as the most effective immunosuppressive drug. Our goal in this study was to determine the relationship between cyclosporine serum level and administered dose in renal transplant recipients in order to find the optimum cyclosporine dose in Kermanshah kidney transplantation center. Methods: This descriptive-analytical study with simple sampling was done on 80 renal transplant recipients (51 males and 29 females) in Kermanshah transplantation center. At least 6 months after transplantation, inpatients with stable conditions, cyclosporine peak and trough levels were measured by specific monoclonal, Radio Immuno Assay (RIA) method over a period of 3 months. Other biochemical parameters were measured too. Data were analyzed by χ 2 and ANOVA tests. Results: Mean cyclosporine Trough and Peak levels were 271.9±85.2 and 904.5±414.2 ng/ml respectively, for the treatment dose of 3.25±1.46 mg/kg B.W. There was no significant difference between trough and peak levels in all three administered doses and the range of administered dose was 1.79-4.71 mg/kg B.W. According to the findings, cyclosporine serum concentrations and the administered dose range differed from other studies. This may be due to pharmacologic and pharmacokinetic differences of the drug and individual physiological characteristics of patients. The minimum dose of 1.79 and maximum dose of 4.71 led to optimum treatment in stable patients and could prevent rejection or toxic effects. Cyclosporine peak level was obviously different from other studies; however it showed better relationship with clinical status. Conclusion: Conversion from the routine cyclosporine Ctrough monitoring to Cpeak monitoring is recommended in Kermanshah kidney transplantation center.