The importance of early cyclosporine levels in pediatric kidney transplantation

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Abstract
We studied the impact of early cyclosporine (CSA) levels on the incidence of rejection in pediatric transplant recipients. Between 1 January 1984 and 31 December 1994, a total of 234 pediatric patients underwent kidney transplants and received CSA immunosuppression. We analyzed the impact of CSA levels (at 1 wk, 2 wk, 1 month, 2 months, and 3 months) on the incidence of rejection in the first 3 and the first 6 months post‐transplant. We found that CSA levels at all timepoints correlated; i.e. recipients with low levels in the early post‐transplant period tended to have low levels throughout the first 12 months. Multivariate analysis for risk factors for biopsy‐proven rejection in the first 3 months revealed that the CSA trough level was the critical factor (p<0.05). Recipients with CSA trough levels 100 ng/ml. Similarly, the CSA trough level at 1 month was the critical risk factor for biopsy‐proven rejection within the first 6 months (p<0.05). The major risk factor for graft loss within the first 12 months was a biopsy‐proven rejection episode. We conclude that in pediatric kidney transplant recipients, early CSA trough levels <100 ng/ml are associated with a significantly increased incidence of rejection in the first 6 months post‐transplant.