title: The importance of early cyclosporine levels in pediatric kidney transplantation.
abstract: We studied the impact of early cyclosporine (CSA) levels on the incidence of rejection in pediatric transplant recipients. Between 1 January 1984 and 31 December 1994, a total of 234 pediatric patients underwent kidney transplants and received CSA immunosuppression. We analyzed the impact of CSA levels (at 1 wk, 2 wk, 1 month, 2 months, and 3 months) on the incidence of rejection in the first 3 and the first 6 months post-transplant. We found that CSA levels at all timepoints correlated, i.e. recipients with low levels in the early post-transplant period tended to have low levels throughout the first 12 months. Multivariate analysis for risk factors by biopsy-proven rejection in the first 3 months revealed that the CSA trough level was the critical factor (p < 0.05). Recipients with CSA trough levels < 100 ng/ml had 2.24 times the risk of rejections vs. those with blood levels > 100 ng/ml. Similarly, the CSA trough level at 1 month was the critical risk factor for biopsy-proven rejection within the first 6 months (p < 0.05). The major risk factor for graft loss within the first 12 months was a biopsy-proven rejection episode. We conclude that in pediatric kidney transplant recipients, early CSA trough levels < 100 ng/ml are associated with a significantly increased incidence of rejection in the first 6 months post-transplant.
authors.affiliation: University of Minnesota, Department of Surgery, Minneapolis 55455, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Matas
authors.forename: K J
authors.initials: KJ
authors.lastname: Gillingham
authors.forename: B M
authors.initials: BM
authors.lastname: Chavers
authors.forename: T
authors.initials: T
authors.lastname: Nevins
authors.forename: C
authors.initials: C
authors.lastname: Kashtan
authors.forename: S M
authors.initials: SM
authors.lastname: Mauer
authors.forename: W D
authors.initials: WD
authors.lastname: Payne
authors.forename: R
authors.initials: R
authors.lastname: Gruessner
authors.forename: J S
authors.initials: JS
authors.lastname: Najarian
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine