Does the switch from sandimmun to Sandimmun neoral reduce patient need for Phenihydine?

In patients receiving cyclosporine A (CyA)-based immunosuppressive therapy, Ca2+ channel blockers (CCBs) prevent the development of CyA-related nephrotoxicity in which increased Ca2+ content plays an important role. We evaluated the dynamics of the intracellular (erythrocytes) and extracellular (plasma) Ca2+ levels and the influence of the CCB, Phenihydine, on this process during the conversion from Sandimmun (S) to Sandimmun Neoral (SN). Forty-two patients were enrolled. The conversion from S to SN normalized the elevated CA2+ level of erythrocytes in groups with Phenihydine (n = 20) and without Phenyhidine (n = 12) 4 weeks after the switch (P < 0.05); this level remained stable until the end of study. Therefore we suggest that the switch from S to SN is effective in reducing elevated intracellular Ca2+ levels. The decrease of Ca2+ content in erythrocytes was similar in all groups switched to SN (with or without Phenihydine). The last effect should be an important argument to focus the further long-term investigations on the ability of CCBs to act as cytoprotective and neophroprotective agents during immunosuppressive protocols with the new microemulsion formulation of CyA.

Effect of Sandimmun Neoral on the level of bivalent cations in erythrocytes of kidney transplant recipients.

In a 4 month study, a group of 16 patients with stable renal graft function receiving triple immunosuppressive therapy including cyclosporin A (Cy A) were investigated for the levels of calcium, magnesium and zinc in erythrocytes. The patients were randomized to be converted to the new microemulsion formulation (Sandimmun Neoral) in a 1:1 fashion (n = 8) or to continue with the classical formulation (Sandimmun) (n = 8). The concentrations of creatinine, phosphate, alkaline phosphatase activity, calcium, magnesium and zinc were measured twice a month in blood plasma. The concentration of calcium, magnesium and zinc in erythrocytes was also measured. The concentration of magnesium in blood plasma and erythrocytes during the study showed no deviation from normal values. The level of zinc in erythrocytes was almost twice as high as in normal healthy controls and was not dependent on Cy A formulation. Calcium content in erythrocytes of patients receiving Sandimmun was 27.6% higher than in healthy persons. Conversion of the patients to Sandimmun Neoral normalized the calcium concentration in erythrocytes and caused a transient increase of calcium levels in blood plasma.

[Hypophosphatemia after successful transplantation of the kidney. Clinico-experimental study]. / Hypophosphatämie nach erfolgter Transplantation der Niere. Klinisch-experimentelle Untersuchung.

The dynamic of indices changes of phosphorus treatment with nefrons in 16 patients after kidney transplantation was studied. The transitory hypophosphatemia accompanied with urine was typical in the majority of patients. The decrease of reabsorption and elevation of phosphorus clearance were noted. In a number of cases the phosphatemia level was increased due to reduction of prednisolone doses. It was experimentally revealed that prednisolone reduces the phosphorus absorption in intestine at 25% and the treatment by 1,25-dihydroxy-vitamin D3 and 1 alpha-hydroxyvitamin D3 promotes the normalization of this process.

[The function of the isolated heterologous liver perfused with the human blood (author's transl)]. / Funktion der isolierten heterogenen Leber bei ihrer Perfusion durch Menschenblut

The metabolic changes and their influence on the isolated liver were studied in 21 experiments on pig liver, perfused with human blood during the period of 3 hrs. It was detected, that rather active carbohydrate and nitrogenic metabolism has been maintained in the liver during 1.5-2 hrs. But after the 2nd hr of perfusion the phenomens of perfusion the phenomens of hypoxia increased, that caused the inhibition of metabolic processes and leaded to deterioration of liver function. The experience of clinical perfusions showed, that the functional activity of assisted liver over the period of 90 min was so depressed, that the organ couldn't provide positive clinical effect.