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Influence of external biliary drainage on cyclosporin A (Neoral ® ) absorption in a pediatric liver transplant recipient
Author(s) -
Zylberkatz Ester,
Verstandig Anthony,
Granot Esther
Publication year - 1999
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1034/j.1399-3046.1999.00032.x
Subject(s) - medicine , immunosuppression , anastomosis , prednisone , gastroenterology , trough level , urology , surgery , biliary drainage , transplantation , tacrolimus
We report on a patient who underwent a liver transplant 8 yr ago at the age of 2. The post‐operative course and further follow‐up were uneventful, maintaining immunosuppression with cyclosporin A (CsA) (Sandimmune ® ) and prednisone; 1.5 yr ago, the patient was converted to Neoral ® . The mean ± SD trough CsA level was 127 ± 37.2 ng/mL, when the patient was maintained on a daily dose of 180 mg. Following an increase in γ‐GTP levels, a biliary‐enteric anastomotic stricture was found. Dilatation was performed and a tube placed for external biliary drainage. Three days later the trough CsA level was at the limit of detection; consequently, the Neoral dose was increased to 480 mg/d. CsA concentration measured 5 days later reached 164 ng/mL. After restoring internal biliary drainage the dose was decreased to 180 mg/d and the CsA level was 142 ng/mL. Later on the CsA dose was further reduced to 160 mg/d (a third of the dose during external biliary drainage) and trough levels were maintained at 90–120 ng/mL. We suggest that CsA dose adjustment and continuous drug monitoring are necessary when bile flow is compromised, in order to prevent rejection of the transplanted liver.