Low Levels of Cyclosporine Best in Transplants

A new study on the incidence of liver cancer following transplant has found that high levels of the immunosuppressant cyclosporine may lead to tumor recurrence. This finding was reported in the May 2005 issue of Liver Transplantation.

Led by Dr. Marco Vivarelli, of the department of surgery and transplantation at the University of Bologna (Italy; www.unibo.it), the study examined 70 patients who took cyclosporine as the main immunosuppressant following liver transplants between 1991 and 2002. The cyclosporine dosage was determined by the clinician in charge, based on clinical and biochemical indications, but without regard to blood levels achieved by the drug after it was administered. Hepatocellular carcinoma (HCC) recurred in seven of the patients between two and 40 months after transplant. The researchers found that the absence of recurrence was significantly related to blood levels of cyclosporine, which were higher in patients who tumors recurred. Other factors, such as gender, underlying liver disease, or the use of cyclosporine with other immunosuppressants did not affect tumor recurrence.

Since higher and lower levels of cyclosporine did not affect rejection rates, the researchers suggest that minimum dosage levels of the drug can be safely used. In addition, they suggest that immunosuppressive schedules be tailored to individual patients based on the biology of their tumors, keeping in mind that high-risk patients would probably benefit from keeping cyclosporine levels as low as possible.




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