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- Title
Analysis of liver function in renal transplant recipients undergoing C2-monitoring for cyclosporine.
- Authors
Hecking, Manfred; Kainz, Alexander; Schillinger, Martin; Posch, Christian; Birsan, Tudor; Rasoul-Rockenschaub, Susanne; Böhmig, Georg A.; Schmaldienst, Sabine; Watschinger, Bruno; Hörl, Walter H.; Mühlbacher, Ferdinand; Säemann, Marcus D.
- Abstract
There exists no systematic evaluation of liver function in renal allograft recipients undergoing C2-monitoring with Neoral® [cyclosporine A (CsA)-microemulsion]. In the present cohort analysis, we compared the hepatic profiles of C2-monitored ( n = 80), C0-monitored ( n = 81), and non-CsA-treated renal allograft recipients ( n = 29), transplanted between 1/1999 and 2/2004 in our institution. While the C2-targets were set in accordance with ( n = 72) or below ( n = 8) the consensus on Neoral® (1500 ± 200 ng/ml), non-CsA-patients received FK506 ( n = 29), partially in combination with rapamycin ( n = 13) as primary immunosuppression. Analysis of maximum hepatic laboratory parameters and also repeated measures byanova within 30 days post-transplant revealed highly significant elevations of direct, indirect and total bilirubin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and lactate dehydrogenase ( P < 0.001) in the C2-group, in comparison with the C0- and the non-CsA-group. Bilirubin-levels were by far the most affected of all hepatic parameters, and correlated with C2-levels ( r2 = 0.62). Seventeen CsA-patients had excessive bilirubin-elevations (>4 mg/dl) and were therefore considered to be ‘CsA-sensitive’ [14 C2-patients (17% of all C2-patients), 3 C0-patients (4% of all C0-patients)]. Bilirubin- and the other parameter elevations in these patients were reversible upon withdrawal or lowering of CsA. Most ‘CsA-sensitive’ patients ( n = 12, 70%) displayed pre-transplant hepatic impairment, indicating a pre-existing liver instability. Collectively, our data emphasize the need for increased awareness toward individual predispositions for CsA-sensitivity.
- Subjects
TRANSPLANTATION of organs, tissues, etc.; HOMOGRAFTS; CYCLOSPORINE; RAPAMYCIN; IMMUNOSUPPRESSION; BILIRUBIN; COHORT analysis
- Publication
Transplant International, 2008, Vol 21, Issue 3, p223
- ISSN
0934-0874
- Publication type
Article
- DOI
10.1111/j.1432-2277.2007.00563.x