Abstract
BackgroundThe blood concentration of cyclosporine (CyA) is frequently elevated following the transfusion of red blood cell concentrate (RCC) to patients after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to identify the variable factors affecting changes in the blood concentration of CyA before and after transfusion of RCC.MethodsWe enrolled 105 patients (age, 5–66 years) who received both CyA and transfusion after HSCT. The ratio of the measurement after transfusion to the measurement before transfusion was calculated for the hematocrit and blood concentration/dose ratio of CyA (termed the HCT ratio and the CyA ratio, respectively).ResultsThe blood concentration/dose ratio of CyA was increased after transfusion compared with before transfusion (P < 0.001). The HCT ratio was significantly correlated with the CyA ratio (P = 0.23, P < 0.001). The HCT ratio, concomitant medication that could elevate CyA concentration after RCC transfusion, and difference in the alkaline phosphatase level between before and after transfusion (ΔALP) were explanatory variables associated with the variation in the CyA ratio. There was no correlation between the CyA concentration after transfusion and the change in the estimated glomerular filtration rate.ConclusionsA change in the blood concentration/dose ratio of CyA was found to be associated with a change in the HCT, concomitant medication that could elevate CyA concentration after RCC transfusion, and ALP levels. If the HCT level rises significantly after RCC transfusion, clinicians and pharmacists should pay attention to changes in the blood CyA concentration.
Highlights
The blood concentration of cyclosporine (CyA) is frequently elevated following the transfusion of red blood cell concentrate (RCC) to patients after allogeneic hematopoietic stem cell transplantation (HSCT)
The following information was obtained for each patient: age, sex, primary disease, donor type and stem cell, body weight measured closest to the day of the RCC transfusion, CyA dose, HCT levels, white blood cell (WBC) counts, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, alkaline phosphatase (ALP) levels, total bilirubin (Tbil) levels, serum albumin (Alb) levels, serum urea nitrogen (UN) levels, serum creatinine (Scr) levels, serum potassium (K) levels, RCC transfusion volumes, concomitant medications, and blood concentrations of CyA
Multiple regression analysis revealed that the HCT ratio and concomitant medication that could elevate CyA concentration after RCC transfusion were explanatory variables associated with the variation in the CyA ratio (Table 3)
Summary
The blood concentration of cyclosporine (CyA) is frequently elevated following the transfusion of red blood cell concentrate (RCC) to patients after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to identify the variable factors affecting changes in the blood concentration of CyA before and after transfusion of RCC. Population pharmacokinetic (PPK) studies have demonstrated that the HCT level is inversely correlated with CyA clearance in HSCT patients [12,13,14] and in recipients of other types of transplants [15] These reports suggested that RCC transfusion has some effects on the blood CyA concentration, the variable factors affecting changes in the blood concentration of CyA before and after transfusion of RCC have not been understood
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