title: Hepatic venous stenosis-related reduction of cyclosporin clearance in a pediatric patient after liver transplantation.
abstract: A 20-month-old girl with Alagille syndrome developed stenosis of hepatic venous anastomosis after living related-donor liver transplantation. Cyclosporin (a microemulsion formulation) was given orally at a dose of 50 mg twice daily, and the trough blood concentration was relatively stable. Before balloon angioplasty of the hepatic vein, trough cyclosporin blood concentrations became elevated and consequently, the dosage was reduced to 15 mg twice daily. On the day of angioplasty, the calculated elimination rate constant of cyclosporin was 0.036 hr(-1), while its apparent basal value was 0.078 hr(-1). The cyclosporin trough concentration to dosage (C/D) ratio gradually increased reaching the maximum on the day after angioplasty. Thereafter, the C/D ratio promptly decreased. Thus, it is speculated that the increase in cyclosporine C/D ratio was mainly dependent on reduction of hepatic clearance of cyclosporin due to hepatic congestion caused by the stenosis of the hepatic venous anastomosis.
authors.affiliation: Department of Clinical Pharmacology and Center for Clinical Pharmacology and Therapeutics, Jichi Medical School, Tochigi, Japan. ksugi@jichi.ac.jp
authors.forename: Koh-Ichi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Masami
authors.initials: M
authors.lastname: Ohmori
authors.forename: Akio
authors.initials: A
authors.lastname: Fujimura
authors.forename: Koh-ichi
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sudoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
authors.forename: Shuji
authors.initials: S
authors.lastname: Hishikawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kitamura
authors.forename: Hideo
authors.initials: H
authors.lastname: Kawarasaki
mesh_terms: D003251:Constriction, Pathologic / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D006503:Hepatic Veins / Q000473:pathology; D006504:Hepatic Veno-Occlusive Disease / Q000097:blood*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008657:Metabolic Clearance Rate / Q000187:drug effects / Q000502:physiology
chemical_list: D016572:Cyclosporine