Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

The high variation of pharmacokinetic profile and short limited time during early post-transplantation period make it hard to adjust the cyclosporine dose that can reach that target level on time. A retrospective design was adopted for this study. It was conducted on 60 patients selected randomly, subdivided into three groups; group1 (n=20) received a single dose of cyclosporine pre-transplant (C2 levels 800-1500), group 2 (n=20) received cyclosporine induction by 4mg/kg 48hours before transplantation (C2 levels 450-800) and group 3 (n=20) received cyclosporine induction by 2mg/kg 48hours before transplantation (C2 levels 800-1200). All groups received steroids and MMF according to standard protocol. We found that pre-transplant administration of cyclosporine helped to achieve therapeutic level of cyclosporine earlier post-transplantation (65% in group 1, 100% in group 2, 100% in group 3) with the need of low doses to maintain cyclosporine level within the therapeutic range during 1-year follow up (P value <0.01). That was reflected upon the lower number of cases complicated by cyclosporine nephrotoxicity (25%, 0%, 5% in group 1, 2, 3 respectively P value <0.039). As regards graft rejection, there was no significant effect (4, 2, 3 patients of group 1, 2, 3 respectively P value 0.67). In addition, we found that early withdrawal of cyclosporine was a better on graft function than a lower dose with late withdrawal. That was evidenced by lower serum creatinine levels all through the 1-year follow up period in group 2 than group 3( mean creatinine level after 1-year was 1.28 ,1.63 respectively)

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