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How common is delayed cyclosporine absorption following liver transplantation?
Author(s) -
Yantorno Silvina E.,
Varela Eva B.,
Raffa Sebastián R.,
Descalzi Valeria I.,
Gomez Carretero Maria L.,
Pirola Daniel A.,
Ruf Andres E.,
Martinez Carabuz Gretel I.,
Podesta Luis G.,
Villamil Federico G.
Publication year - 2005
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20341
Subject(s) - medicine , absorption (acoustics) , liver transplantation , incidence (geometry) , transplantation , gastroenterology , surgery , materials science , physics , optics , composite material
The mean time to peak absorption of cyclosporine (CsA) in liver transplant patients is approximately 2 hours, but in some patients the peak occurs later. The goal of this study was, therefore, to investigate the incidence of delayed absorption in 27 de novo liver transplant recipients receiving CsA ≥10 mg/kg/day (C 2 monitoring) and in 15 maintenance patients. Patients were categorized as ‘normal’ absorbers (C 2 exceeding C 4 and C 6 ) or ‘delayed’ absorbers (C 4 or C 6 exceeding C 2 ), and as ‘good’ (>800 ng/mL at C 0 , C 2 , C 4 , or C 6 ) or ‘poor’ absorbers (C 0 , C 2 , C 4 and C 6 <800 ng/mL) on the day of study. Among de novo patients, 15 (56%) had ‘normal’ CsA absorption and 12 (44%) ‘delayed’ absorption. Good CsA absorption occurred in 16 patients (59%) and poor absorption in 11 (41%). The proportion of poor absorbers was similar in patients with normal (6 / 15, 40%) or delayed (5 / 12, 42%) absorption. Among the 12 delayed absorbers, 11 had peak CsA concentration at C 4 . Mean C 0 level was significantly higher in delayed absorbers (282 ± 96 ng/mL) than in normal absorbers (185 ± 88ng/mL; P = .01). Delayed absorbers reverted to normal absorption (C 2 > C 4 ) after a median of 6 days from the day of study, and no cases of delayed absorption were found among maintenance patients. In conclusion, almost 50% of the patients had delayed CsA absorption early posttransplant; around half of these exhibited normal CsA exposure. Measurement of C 4 in addition to C 2 differentiates effectively between delayed and poor absorbers of CsA such that over‐ or underimmunosuppression can be avoided. (Liver Transpl 2005;11:167–173.)