title: Pharmacokinetic analysis of cyclosporine in a renal transplant recipient with congenital absence of the portal vein.
abstract: Here we report therapeutic drug monitoring of cyclosporine in a kidney transplant recipient lacking enterohepatic circulation. The patient developed steroid-resistant nephrotic syndrome at age 14 years, and was medicated with an oral cyclosporine microemulsion. However, her cyclosporine trough level was unexpectedly elevated, and subsequent investigations showed that she was deficient in drug metabolism as a result of the congenital absence of the portal vein. Her renal function gradually decreased and she became dialysis-dependent at the age of 21 years, and kidney transplantation was planned. Based on pretransplant therapeutic drug monitoring, we started cyclosporine microemulsion at half of the conventional dosage. After transplantation, the dosage was successfully adjusted to achieve a target trough level. The post-transplant course was stable with no symptoms of rejection or cyclosporine-associated nephrotoxicity.
authors.affiliation: Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Ryuto
authors.initials: R
authors.lastname: Nakazawa
authors.affiliation: Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Chikaraishi
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016572:Cyclosporine / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D016903:Drug Monitoring; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D016030:Kidney Transplantation / Q000009:adverse effects*; D011169:Portal Vein / Q000002:abnormalities*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: congenital absence of the portal vein; cyclosporine; kidney transplantation; nephrotic syndrome; therapeutic drug monitoring