title: Once-daily oral administration of cyclosporine in a lung transplant patient with a history of renal toxicity of calcineurin inhibitors.
abstract: Cyclosporine is usually administered orally in two divided doses every 12 h in transplant patients. However, some patients have difficulty in achieving therapeutic levels after transplantation. In fact, cyclosporine is reportedly administered once daily in renal and liver transplantation cases, but not in lung transplantation cases. We report a patient with a history of calcineurin inhibitor-induced renal toxicity who successfully underwent living-donor lobar lung transplantation (LDLLT) with the novel immunosuppressive strategy of once-daily administration of cyclosporine. An 18-year old man with progressive respiratory insufficiency after bone marrow transplantation was referred to our hospital for lung transplantation. He had a history of renal toxicity due to calcineurin inhibitors. Based on his history of tacrolimus- and cyclosporine-induced renal toxicity, we decided to initiate basiliximab as induction therapy, followed by once-daily cyclosporine administration to obtain high enough blood cyclosporine concentrations at 2 h post-dose (C2) and lowered trough blood concentrations (C0) for protection of renal function as maintenance therapy. LDLLT was successfully performed, and the postoperative course was uneventful and free of rejection episodes. Cyclosporine dosing was adjusted with intensive therapeutic drug monitoring of blood cyclosporine levels. One year after LDLLT, the patient is alive and well with no problems with daily life activities.
authors.affiliation: Department of Pharmacy, Kyoto University, Kyoto, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Urology, Kyoto University, Kyoto, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan hdate@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D065095:Calcineurin Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D016572:Cyclosporine; D016559:Tacrolimus
keywords: Calcineurin inhibitor; Induction therapy; Lung transplantation; Renal toxicity