CYCLOSPORINE PLASMA LEVELS IN RENAL TRANSPLANT PATIENTS

Abstract

In 69 renal allograft recipients the highest-tolerated dose was given with respect to clinical events but without respect to the CsA plasma level (CsA-PL). The CsA dose was gradually decreased during the first 6–12 months after transplantation, and in some patients even later. The CsA dose after 12 months was 5–8 mg/kg/day and after 18 months 4–6 mg/kg/day, resulting in CsA-PL of 85–140 ng/ml and <50–110 ng/ml, respectively. CsA side-effects were usually seen in patients with high CsA-PL, but they were also encountered at levels normally seen in patients without toxicity. In the individual patient, acute CsA nephrotoxicity was associated with a significant rise in CsA-PL. In patients with acute nephrotoxicity a reduction of the CsA dose (mean 24%) was necessary to regain satisfactory renal function. All patients with several consecutive CsA-PL above 1000 ng/ml had hepatotoxicity or nephrotoxicity, or both, associated with severe morbidity and mortality.