Changes in trough levels of whole blood cyclosporine and graft function of a kidney transplant recipient with onset of hypothyroidism after transplantation.
The immunosuppressive and toxic effects of cyclosporine (CsA) are affected by many factors. We present the first case of a kidney transplant patient who had an onset of hypothyroidism about two months after the transplantation. In this case, trough levels of whole blood CsA and total serum cholesterol levels increased at the same time. But the decrease in renal function was not as severe as expected from the very high trough levels of whole blood CsA. Elevation of the trough level of whole blood CsA may be due to a decrease in CsA clearance resulting from the decreased cytochrome P-450 activity in hypothyroidism. Furthermore, a decrease in thyroid hormone level and increase in plasma lipoprotein level might have affected the distribution of CsA, and this change might have influenced the toxic effect of CsA In conclusion, our case suggests that thyroid function and plasma lipoprotein level should be considered important factors that affect the pharmacokinetics and action of CsA.
Nishimura
M
M
Department of Internal Medicine, Sakura National Hospital, Chiba, Japan.
Yamada
K
K
Matsushita
K
K
Sakamoto
K
K
Saisu
T
T
Kashiwabara
H
H
Yokoyama
T
T
D000328:Adult; D016572:Cyclosporine / Q000097:blood* / Q000493:pharmacokinetics; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D006801:Humans; D007037:Hypothyroidism / Q000097:blood* / Q000201:enzymology / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology*; D008297:Male
D016572:Cyclosporine; D003577:Cytochrome P-450 Enzyme System