This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. We currently follow over 4,000 kidney transplant patients in the outpatient clinic at the University of Alabama Medical Center in Birmingham. The vast majority of these patients are taking cyclosporine as maintenance immunosuppression. Cyclosporine has been the cornerstone of immunosuppression for solid organ transplant recipients since its introduction into routine clinical practice. However, cyclosporine has not been reached the full therapeutic potential due to its low oral absorption and high intra- and inter-patient variability of absorption and exposure. Traditionally, pre-dose blood concentration monitoring has been utilized as a way to titrate the cyclosporine dose to a designated range that is considered therapeutic with acceptable tolerability. This state is complicated by a narrow therapeutic index of cyclosporine evidenced by the presence of either acute rejection or nephrotoxicity in patients having cyclosporine trough concentrations within the target range. Recently, there has been speculation that looking at the level of cyclosporine around the peak absorption time, 2 hours after ingesting cyclosporine, may be a more useful basis for adjusting dose. However, information in this area is not sufficiently defined. This project will be dependent on accurate sampling times and documentation which can be performed in the GCRC.
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