THE IMPACT OF CYCLOSPORINE DOSE AND LEVEL ON ACUTE REJECTION AND PATIENT AND GRAFT-SURVIVAL IN LIVER-TRANSPLANT RECIPIENTS

A multicenter, retrospective analysis of 623 liver transplant recipien ts was performed to define safe and effective cyclosporine doses and b lood levels at various times after transplantation. Patient and graft survival were assessed as efficacy parameters, and serum creatinine an d cholesterol levels as safety parameters, The mean daily cyclosporine dose was 12.1 mg/kg/d at 1 month posttransplantation and 5.5 mg/kg/d after 1 year, After 4 years, the mean cyclosporine dose was maintained at 4.0 mg/kg/d, Mean cyclosporine blood levels showed a similar trend , Patient and graft survival after 4 years of cyclosporine maintenance therapy were 72% and 67%, respectively, Both serum creatinine and cho lesterol levels were stable over the study period, and neither correla ted with cyclosporine dose, The cumulative incidence of biopsy-proven acute cellular rejection was 59% for early (<6 months) episodes and 21 % for late (greater than or equal to 6 months) episodes, Patient and g raft survival did not differ significantly between patients experienci ng early or late acute rejection episodes and those who did using univ ariate analysis, The high patient and graft survival, low rejection ra tes, and lack of significant renal dysfunction or hypercholesterolemia suggest that the cyclosporine doses and blood levels described are sa fe and therapeutically effective. Copyright (C) 1998 by the American A ssociation for the Study of Liver Diseases.