RESUMO
BACKGROUND: Pre dose or trough blood cyclosporine (CSA) concentration is routinely monitored and the result is used to alter patient's drug dosing. Patients with identical pre dose blood CSA may have very different systemic exposure to the drug. Recently CSA 2 hour post dose level [C2] has been reported to correlate better with drug exposure. We undertook this study to evaluate the influence of trough and C2, CSA concentration monitoring on short-term renal allograft outcomes. METHODS: 25 patients of renal transplant receiving a triple drug regimen of CSA micro emulsion (Panacea Biotec) 8mg/kg, azathioprine 1mg/kg and prednisolone 0.5mg/kg were analyzed prospectively for graft outcomes. CSA levels were monitored in whole blood by radioimmunoassay using monoclonal antibodies, at 72 hours after the transplant. RESULTS: The mean age of patients was 37.08 + 9.1 years. There were 20 males and 5 females. The mean age of donors was 40.2 + 8.2 years. There were 11 related donors with at least a haplomatch, 4 spousal and 10 unrelated donors with a nil antigen match. The mean pre dose CSA concentration was 289.22 + 171.9ng/ml; range (98.8 + 783.41ng/ml). The CSA concentration at 2 hours after the CSA administration was 838 + 310.87ng/ml (range, 169 + 1268ng/ml). 3 (12%) patients had acute rejection. In these patients the mean pre dose CSA concentration was 328.67ng/ml and the mean C2, CSA concentration was 1006.26ng/ml. CSA induced hemolytic uraemic syndrome was diagnosed in one patient. The trough and C2, CSA concentration levels were 174 and 870.83ng/ml respectively in this patient. CONCLUSION: In our study CSA levels, trough and peak showed significant inter patient variability. The trough and C2 concentration levels did not correlate with the episodes of acute rejection. We conclude that in a triple drug regimen with fixed dosing schedules routine trough CSA level monitoring is not helpful in the acute post renal transplant period.
RESUMO
Forty-six patients with end stage renal disease underwent forty-eight arteriovenous fistula formation by the Brescia-Cimino method between Jan 1994 and Jan 1997. The purpose of the fistula in all cases was to provide angioaccess for haemodialysis through the arterialised veins. Thirty-five (72.9%) of these fistulas were made on males, the remaining being on females. Mean age of the patients was 35.9 years. The fistulas were created in the left upper limb in 40 cases (83.3%) and the right upper limb was used in 8 cases (16.7%). The distal third of the forearm was used in all cases. During follow up, thirty-nine (94.1%) fistulas functioned for durations between 6 months to 2 years (average follow up of 14 months), permitting a mean of 2 dialysis per week. Seven cases (14.6%) had early fistula blockage. The end point for follow up was a successful renal transplant in the majority of patients. Except for nonpatency, and limb edema in two cases, no other complications were encountered.
