Journal article
Dose-adjusted cyclosporine C2 in a patient with jejunoileal bypass as compared to seven other liver transplant recipients
Therapeutic drug monitoring, Vol.25(6), pp.665-670
2003
DOI: 10.1097/00007691-200312000-00004
PMID: 14639052
Abstract
Jejunoileal bypass (JIB) is a weight loss procedure in which malabsorption is produced by connecting a short length of proximal jejunum to the distal ileum. Because 90% of the small intestine is bypassed, it may have impact on the dose-concentration response of oral cyclosporine (CsA). The authors characterized the dose-adjusted blood concentrations of CsA obtained 2 hours (C2) after oral microemulsion CsA (ME-CsA) in a liver transplant (LTx) subject with an intact JIB, as compared with those from seven LTx controls without JIB. The biliary reconstruction involved choledocho-choledochostomy without external drainage in all patients. ME-CsA was administered via a nasogastric tube within 24 hours after graft reperfusion. Oral fluconazole was given prophylactically to the study subject only for 6 days after LTx. During the first week after LTx, the dose-adjusted C2 (mean ± SD) for the study subject and for controls was 53 ± 10 and 106 ± 47 ng/mL, respectively (P < 0.001). The corresponding value during the period from day 7 to day 107 was 105 ± 40 and 257 ± 86 ng/mL, respectively (P < 0.001). Multiple linear regression revealed that dosage, days after LTx, and the presence of a JIB were all independent predictors of C2 (R2 = 0.798, P = 0.037). Lack of bile resulting in malabsorption of ME-CsA was not thought to be significant contributor to her low dose-adjusted C2 because there was no external bile drainage and a portion of terminal ileum, where most bile acid reabsorption occurred, was still available after JIB. The fact that fluconazole failed to increase the dose-adjusted C2 in the study subject supports that enteric clearance of CsA may become clinically unimportant after JiB. Therefore, the low dose-adjusted C2 is most likely explained by the reduced bowel length and associated absorptive surface area after JIB. In conclusion, patients with JIB may require higher doses of ME-CsA.
Details
- Title: Subtitle
- Dose-adjusted cyclosporine C2 in a patient with jejunoileal bypass as compared to seven other liver transplant recipients
- Creators
- Rou-Yee Chenhsu - University of Iowa Hospitals and ClinicsYOUMIN WU - University of IowaDaniel Katz - University of IowaStephen Rayhill - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Therapeutic drug monitoring, Vol.25(6), pp.665-670
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/00007691-200312000-00004
- PMID
- 14639052
- ISSN
- 0163-4356
- eISSN
- 1536-3694
- Language
- English
- Date published
- 2003
- Academic Unit
- Surgery
- Record Identifier
- 9984321871902771
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