The importance of early cyclosporine levels in pediatric kidney transplantation

Arthur J. Matas, Kristen J. Gillingham, Blanche M. Chavers, Tom Nevins, Cliff Kashtan, S. Michael Mauer, William D. Payne, Rainer Gruessner, John S. Najarian

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

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 for 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 rejection 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.

Original languageEnglish (US)
Pages (from-to)482-486
Number of pages5
JournalClinical Transplantation
Volume10
Issue number6 I
StatePublished - Dec 1 1996

Keywords

  • Cyclosporine
  • Pediatric patients
  • Renal transplant

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