Correlating Levels Of Cyclosporine Drug And Clinical Presentations In Renal Transplant Patients: An Approach To Understand Drug Induced Adverse Effects

Abstract

Purpose: Cyclosporine is a calcineurin inhibitor that acts as an immunosuppressant by blocking T-cell activation and is used for
immune-suppression in renal transplantation. Its adverse effects include tremors, hyperplasia, hirsutism, hypertension, hyperuricemia,
hyperlipidemia, etc. We aim to correlate clinical presentations and cyclosporine drug level in renal transplant patients and explore
cyclosporine toxicity in clinical practice.
Methods: We enrolled 50 renal transplant patients (44 males and 6 females; age range: 26 to 58 years) at 3 months post-transplant in
this observational study, which was conducted at Nephrology Department, Al Basrah General Hospital (January 2016-June 2017).
Clinical examination was conducted for tremors, gum hypertrophy and hirsutism. Regular monitoring of cyclosporine trough (C0) drug
level was carried out along with other routine investigations.
Results: Mean cyclosporine trough drug level was calculated to be 270 ng/mL ±123.2. Our study showed significantly increased
incidence of cyclosporine toxicity in male patients (22%) as compared to female patients (10%) and in the age group of 30-50 years
(24%) (p=0.017). Higher cyclosporine trough levels significantly increased incidences of tremors in 13 (26%), gum hypertrophy in 12
(24%), bone pain in 6 (12%), hirsutism in 13 (26%), nephrotoxicity in 5 (10%), hyperuricemia in 7 (14%) and hyperkalemia in 7 (14%)
renal transplant patients as compared to patients with normal cyclosporine therapeutic trough level (p=0.0001 for all).
Conclusion: Overall data emphasizes that concurrent evaluation of clinical presentations and monthly cyclosporine drug level is
essential to achieve optimal medical care for renal transplant patients and avoid drug-induced adverse effects.
Trial Registration: Not available