Efficacy and safety of constant-rate intravenous cyclosporine infusion immediately after heart transplantation.
Oral cyclosporine therapy immediately after heart transplantation is erratic and difficult to predict. The purpose of this study was to evaluate the relative efficacy and safety of cyclosporine when administered by constant-rate infusion immediately after transplantation. Nineteen patients (17 men and two women) aged 50 years (range 25 to 61 years) who weighed 71 +/- 9 kg, participated in the study and received cyclosporine, 7 to 10 mg/hr (117 +/- 15 micrograms/kg/hr). The infusions were initially maintained for 26 +/- 5 hours (range 18 to 42 hours) without adjustments in dosage. Whole blood samples were obtained at hourly intervals for the first 8 to 12 hours and then daily throughout the 7-day study period and were analyzed by high-performance liquid chromatography. Constant-rate cyclosporine infusion resulted in therapeutic blood levels (350 to 450 ng/ml) at 6 hours. These levels remained relatively steady throughout the 7-day infusion, requiring only minimal dosage adjustments. Kidney function was not altered significantly after 7 days of intravenous cyclosporine therapy as evidenced by a mean serum creatinine level of 1.3 mg/dl before therapy and 1.4 mg/dl after therapy. There, however, was a transient rise in serum creatinine level in most patients on the second or third day after transplantation that resolved without a reduction in cyclosporine dosage. The mean endomyocardial biopsy score at 1 week after transplantation was 0.1, and only four of the patients required additional immunosuppressive therapy to treat rejection during the first 6 weeks after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
Schroeder
T J
TJ
College of Medicine, University of Cincinnati Medical Center, Ohio 45267-0714.
Myre
S A
SA
Melvin
D B
DB
Van der Bel-Kahn
J
J
Stephens
G W
GW
Collins
J A
JA
Wolf
R K
RK
Brown
L L
LL
Pesce
A J
AJ
First
M R
MR
D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D006084:Graft Rejection / Q000187:drug effects; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007262:Infusions, Intravenous / Q000379:methods; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011182:Postoperative Care; D013997:Time Factors
D003524:Cyclosporins; D003404:Creatinine