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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 4  |  Page : 417-418
A Need for a Unified Protocol of Immunosuppression with Cyclosporin in Saudi Arabia


Director General, Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

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How to cite this article:
Shaheen FA. A Need for a Unified Protocol of Immunosuppression with Cyclosporin in Saudi Arabia. Saudi J Kidney Dis Transpl 1995;6:417-8

How to cite this URL:
Shaheen FA. A Need for a Unified Protocol of Immunosuppression with Cyclosporin in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Aug 9];6:417-8. Available from: http://www.sjkdt.org/text.asp?1995/6/4/417/40561
To the Editor:

It is obvious to everybody that protecting the function of the transplanted renal graft is of utmost importance. Due to the donor shortage everywhere, this graft may be the only chance of transplantation the chronic renal failure patient might get. Since the advent of cyclosporin as a main immuno­suppressive drug for maintenance to prevent rejection of transplanted renal grafts, acute rejection has significantly decreased [1] . However, chronic rejection is still the major cause of loss of grafts [2],[3] . There is a belief that the long term cyclosporin dose has major effect on the incidence of chronic renal transplant rejection. The physicians following-up transplant patients use lesser number of milligrams of cyclosporin per kilogram of the body weight, especially after the first year of transplantation, despite the low blood level of cyclosporin. These physicians claim - and they are right - that the blood levels of cyclosporin are not dependable. They are afraid of the chronic toxicity of cyclosporin, which may follow long term large doses. This has not been confirmed by recent studies. Accordingly, I suggest to use a unified protocol of using cyclosporin in the maintenance of renal graft function, simply by preventing the usage of very low doses of cyclosporin i.e.,not to be lower than 2mg per kilogram of body weight per day no matter what theblood level might be, as also was suggested by others [1],[2],[3],[4] . Now that we have better form of cyclosporin (Neoral), which gives predictable blood levels, there will be no excuse not to use these levels to guide dosing. Till the new form of cyclosporin is widely used, and we are sure about the long term outcome of the renal grafts maintained on it, the above recommendation might help.

 
   References Top

1.Almond PS, Gillingham KJ, Sibley R, et al. Renal transplant function after ten years of cyclosporin.Transplantation 1992;53:316-23.  Back to cited text no. 1  [PUBMED]  
2.Almond SP, Matas AJ, Gillingham KJ, et al. Risk factors for chronic rejection in renal allograft recipients. Transplantation 1993;55:752-7.  Back to cited text no. 2    
3.Briggs JD. Incidence and causes of long­term renal allograft loss. Saudi J Kidney Dis Transplant 1994;5:159-62.  Back to cited text no. 3    
4.Salomon DR.Cyclosporin nephrotoxicity and long-term renal transplantation.Transplant Rev 1992;6:10-3.  Back to cited text no. 4    

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Correspondence Address:
Faissal A.M Shaheen
Consultant Nephrologist & Director General, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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PMID: 18583751

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