Nephrotoxicity in bone marrow transplant recipients treated with cyclpsporin A

Abstract

Summary. Cyclosporin A (CyA) is a valuable post graft immunosuppressive agent in allogeneic bone marrow transplantation. The use of CyA is associated with a reduction in severity of graft versus host disease and improved marrow engraftment. A major side effect of CyA is nephrotoxicity. In 33 patients studied during the first 4 weeks of therapy there is a close correlation between trough (12 h) serum cyclosporin A concentrations and plasma creatinine (r=0·93, P < 0·001) and urea (r=0·88, P < 0·001). Trough CyA serum concentrations of > 500 ng/ml are potentially nephrotoxic. Other risk factors for early nephrotoxicity in cyclosporin therapy are the concurrent use of aminoglycoside antibiotics (P=0·01) and hyperbilirubinaemia (P=0·01). Early nephrotoxicity can be prevented by maintaining trough CyA levels in the range 100–400 ng/ml. During prolonged CyA therapy, cumulative renal impairment can occur and nephrotoxic episodes associated with microangiopathic peripheral blood changes and hypertension are seen in a minority of patients.