Níveis de vale de ciclosporina elevados em transplantados renais anti-HCV positivos

Abstract

Objetivo. Comparar os níveis de vale de CsA de transplantados renais anti-HCV+ com um grupo controle. MÉTODOS. Incluímos como casos todos os pacientes anti-HCV+ transplantados entre janeiro de 1992 e abril de 1996, e os anti-HCVtransplantados a seguir do caso como controles. Excluímos pacientes diabéticos, HbsAg+, os que recebiam fármacos com interação com a CsA e aqueles com transaminases elevadas. A sorologia para HCV foi testada pelo método ELISA de 3ª geração, e as dosagens de ciclosporina através de fluorimetria polarizada com anticorpo policlonal. RESULTADOS. As principais variáveis demográficas não diferiram entre os grupos. O nível de vale médio de CsA do primeiro mês pós- transplante foi maior nos 23 pacientes anti-HCV+ (551 ± 280 ng/ ml) do que nos 31 controles (418 ± 228 ng/ml, p<0,05). As diferen- ças tornaram-se aparentes ao final da primeira semana (528 ± 275 versus 344 ± 283 ng/ml; p<0,01) e persistiam no momento da alta (582 ± 284 ng/ml versus 457 ± 229 ng/ml; p=0,08). CONCLUSÃO. Os pacientes anti-HCV+ apresentam níveis de vale de CsA elevados em relação à população controle, o que indica a realização de estudo farmacocinético da droga neste prevalente grupo de transplantados renais.

OBJECTIVE. Compare the CsA trough levels of HCV+ kidney transplant recipients to a control group METHODS. All anti-HCV positive patients that received a renal allograft between January 1992 and April 1996 were initially included as cases. Patients with diabetes mellitus, HBsAg+, who were taking medication that could modify CsA pharmacokinetics and those with elevated aminotransferases were excluded. For each anti-HCV positive index case the following transplanted anti-HCV negative patient was included as a control. Third generation ELISA was used for determination of the anti-HCV status and CsA dosages were performed by polarized fluorometry with polyclonal antibodies. RESULTS. No differences in the demographic variables were found. The average CsA through levels in the first month were higher (551 ± 280 ng/ml) in the 23 cases as compared to the 31 controls (418 ± 228 ng/ml; p< 0.05). The differences became apparent at the end of the first week (528 ± 275 versus 344 ± 283 ng/ml; p<0.01) and persisted at discharge (582 ± 284 versus 457 ± 229; p=0,08). CONCLUSION. We concluded that anti- HCV positive patients have higher blood levels of CsA for a particular dosage, than anti-HCV negative controls. Prospective studies with a more appropriate pharmacokinetic approach are needed to confirm the present findings.