Influence of external biliary drainage on cyclosporin A (Neoral) absorption in a pediatric liver transplant recipient.
We report on a patient who underwent a liver transplant 8 yr ago at the age of 2. The post-operative course and further follow-up were uneventful, maintaining immunosuppression with cyclosporin A (CsA) (Sandimmune) and prednisone; 1.5 yr ago, the patient was converted to Neoral. The mean +/- SD trough CsA level was 127 +/- 37.2 ng/mL, when the patient was maintained on a daily dose of 180 mg. Following an increase in gamma-GTP levels, a biliary-enteric anastomotic stricture was found. Dilatation was performed and a tube placed for external biliary drainage. Three days later the trough CsA level was at the limit of detection; consequently, the Neoral dose was increased to 480 mg/d. CsA concentration measured 5 days later reached 164 ng/mL. After restoring internal biliary drainage the dose was decreased to 180 mg/d and the CsA level was 142 ng/mL. Later on the CsA dose was further reduced to 160 mg/d (a third of the dose during external biliary drainage) and trough levels were maintained at 90-120 ng/mL. We suggest that CsA dose adjustment and continuous drug monitoring are necessary when bile flow is compromised, in order to prevent rejection of the transplanted liver.
Zylber-Katz
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Division of Medicine, Hadassah University Hospital, Jerusalem, Israel. esterzk@hadassah.org.il
Verstandig
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Granot
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D000367:Age Factors; D001662:Biliary Tract Surgical Procedures; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000378:metabolism*; D004322:Drainage; D016903:Drug Monitoring; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000378:metabolism*; D016031:Liver Transplantation; D008297:Male; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine