NEORAL INDUCTION IN PEDIATRIC RENAL-TRANSPLANTATION

Neoral was instituted in pediatric renal transplant patients with the hypothesis it would have more predictable kinetics than Sandimmun. How ever, significant questions have arisen concerning potential toxicity and dosing interval related to its rapid absorption with subsequent hi gh initial peak. This is compounded by the fact that children appear t o metabolize cyclosporine at a greater rate than adults. This combinat ion of a rapid peak and rapid absorption may then result in lower trou gh levels at 12 h. We compared the trough cyclosporine levels of nine children who received Neoral with nine who received Sandimmun at the t ime of initial transplantation. More frequent dosing (every 8 h) was r equired in the Neoral population compared with the Sandimmun populatio n for the Ist month in order to obtain comparable trough levels. Beyon d the initial 4-6 weeks, trough levels were similar for Neoral and San dimmun. Whereas 1-month creatinine levels and blood pressures were sim ilar, the number of blood pressure medications was significantly highe r in the Neoral group. At 5.5 +/- 1.1 months' followup, a single patie nt in the current Neoral group and in the retrospective Sandimmun grou p each experienced a single OKT3 allograft-treated rejection. We sugge st that the area under the curve is different in Neoral than Sandimmun , and the initial dosing frequency may need to be adjusted accordingly .