Therapeutic drug monitoring in pediatric renal transplantation
- Lutz T. Weber
- Pediatric Nephrology
At an international meeting held in Madrid, Spain, experience with a new microemulsion formulation of cyclosporin A, CyA, (Neoral) in pediatric renal and hepatic transplantation was reviewed, with a view to reaching a consensus on optimizing its use in these surgical indications. The management of children receiving CyA as a post-transplant immunosuppressant is often problematic, because CyA absorption from the conventional oral formulation, Sandimmune (SIM), is highly variable, bioavailability is low and clearance is particularly rapid in this patient population. Key discussion issues included improved absorption (reduced variability and greater bioavailability) with Neoral, compared with SIM, the suitability of pharmacokinetic parameters and time points for CyA monitoring, conversion from SIM to Neoral, twice- vs. three-times-daily therapy and the potential to reduce intravenous use of CyA in de novo transplant recipients. It was concluded that the favorable pharmacokinetic characteristics of Neoral, compared with SIM, are likely to simplify the clinical management of young graft recipients and that the consistency of these pharmacokinetic characteristics may provide a tool by which immunosuppressive therapy might be improved.