Cyclosporine absorption following orthotopic liver transplantation

Abstract

Blood concentrations of cyclosporine were determined in adult and pediatric patients following orthotopic liver transplantation to quantitate cyclosporine blood clearance and oral absorption. Seventeen bioavailability studies were performed following transplantation surgery in nine children and seven adults. The intravenous cyclosporine study was performed following an average dose of 2.1 mg/kg. The patients were again studied when they received the same intravenous dose plus an oral dose of cyclosporine of 8.6 mg/kg or an oral dose alone. Blood samples were collected and analyzed for cyclosporine using high-performance liquid chromatography. Cyclosporine blood clearance ranged from 29 to 203 mL/min (1.9-21.5 mL/min/kg) in children and from 253 to 680 mL/min (3.2-7.6 mL/min/kg) in adults. The mean cyclosporine clearance value was 9.3 mL/min/kg in the pediatric patients and 5.5 mL/min/kg in the adults. Cyclosporine bioavailability was less than 5% in six studies on five pediatric patients in the immediate postoperative period. The bioavailability varied from 8% to 60% in adult liver transplant patients (mean, 27%). We conclude that: cyclosporine clearance is highly variable between patients, pediatric patients clear the drug more rapidly than adults and therefore need a higher cyclosporine dose on a body weight basis, cyclosporine is poorly and variably absorbed in liver transplant patients, and cyclosporine blood concentration monitoring is essential following orthotopic liver transplantation.

Figure 1

Cyclosporine blood concentration versus time in adult study patient 16. Concentrations following an intravenous (●– –●) and an oral (x - -x) dose are presented.

Figure 2

Cyclosporine blood concentration versus time in pediatric study patient 6. Concentrations following an intravenous (●– –●) and an intravenous plus oral (x - - x) dose are presented.