Cyclosporine therapeutic monitoring with C(MAX) in kidney transplant recipients: racial considerations.

BACKGROUND

The aim of the study was to assess whether the C(2) level is a good parameter to predict a drug's maximal concentration C(MAX) values in Egyptian kidney transplant recipients (KTR).

METHODS

Fifty stable kidney transplant recipients (KTR) with a previously confirmed diagnosis of schistosomal infection compared to KTR (n = 50) without schistosomal infection regarding CsA concentrations at time 0 (trough), 1.5, 2, 2.5, 3, and 3.5 h post-CsA. Statistical significance of linear regression between different CsA time concentrations and drug dosages was calculated.

RESULTS

Patients in schistosomal group, had significantly lower C(2) levels (511 +/- 118 ng/ml) compared with control group (669 +/- 213 ng/ml) (P < 0.05), whereas C(2.5) level was significantly higher (730 +/- 215 and 527 +/- 129 ng/ml, respectively; P < 0.05). Only C(2.5) in schistosomal group had a significant linear regression relationship with both morning cyclosporine (CsA) dose and CsA dose expressed as mg/kg/day (P = 0.0123, r = 0.573018).

CONCLUSIONS

Egyptian patients have special characteristics in drug absorption and metabolism, mostly due to schistosomal infection, and they may need the use of C(2.5) for monitoring of CsA. If confirmed by subsequent larger experience, these findings may have a significant impact on our management of CyA immunosuppression in clinical renal transplantation in certain ethnicities.