Phenytoin administration in renal allograft recipients on cyclosporine immunosuppression

E. J. Schweitzer, D. M. Canafax, K. J. Gillingham, J. S. Najarian, A. J. Matas

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Phenytoin reduces blood levels of cyclosporine and increases the metabolism of corticosteroids. The current study was designed to determine whether patients taking phenytoin at the time of kidney transplantation experienced a worse outcome. Thirteen patients receiving phenytoin at the time of transplantation were retrospectively compared to a similar cohort not receiving phenytoin with regard to patient and graft survival, rejection episodes, and drug dosing. We did not detect any adverse impact of phenytoin administration on recipients of renal allografts, other than a requirement for higher doses of cyclosporine. There was no significant difference in 5-year actuarial patient or graft survival (PHENYTOIN 92% and 85% vs. NO PHENYTOIN 84% and 77%, respectively), the total number of rejection episodes in 1 yr (10 vs. 6, N.S.), serum creatinine at 1 yr (1.4±0.2 vs. 1.8±0.1, N.S.), or number of days of hospitalization during the transplant admission (18±6 vs. 11±2, N.S.). Generalized seizures occurred in 38% of phenytoin-treated patients in the postoperative period. Despite close monitoring, the levels of cyclosporine during the first 3 months after transplantation were still significantly lower in the patients on phenytoin (136±14 vs. 182±16 ng/ml, p= 0.04). In the patients taking phenytoin, the average requirement for cyclosporine in the 1st yr was more than twice that of patients not taking phenytoin (11.5±1.2 vs. 5.3±0.3 mg/kg/d, p<0.001). These data illustrate the need for attentive cyclosporine monitoring in patients taking phenytoin. If cyclosporine levels are adjusted appropriately, phenytoin administration probably does not markedly influence the results of renal transplantation.

Original languageEnglish (US)
Pages (from-to)9-13
Number of pages5
JournalClinical Transplantation
Volume7
Issue number1 I
StatePublished - Jan 1 1993

Keywords

  • Cyclosporine
  • Kidney transplantation
  • Phenytoin

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