Ciclosporin Muromonab

A 44-year-old black woman with a living-related renal transplant had an acute rejection within 3 months and was given muromonab but was from then on stable. She was later given oral ciclosporin (Neoral 2 mg/kg bd), mycophenolate mofetil 1000 mg bd, and prednisolone 7.5 mg/day. Over 6 months her ciclosporin blood concentrations were consistently below the target concentration of 200 ng/ml. It was then discovered that she had also been taking 2-3 tablets/day of St. John s wort (Your Life, Leiner Health Products, Carson CA, 300 mg standardized to 0.3% hypericin). The St. John s wort was withdrawn and her blood ciclosporin concentrations reached the target within 2 weeks. 

In patients with renal transplants, the overall incidence of infections during the first three posttransplantation months was significantly higher in one trial of patients treated with prophylactic muromonab or ciclosporin (39), but there was no significant difference in the severity of infections in another similar trial (40). Both studies failed to identify any adverse impact of infectious episodes on patient survival. In a comparison of prophylactic ATG-Fresenius with muromonab there were more common... 

A 49-year-old woman taking ciclosporin, prednisolone, and mycophenolate developed acute refractory rejection 4 days after renal transplantation. After an unsuccessful glucocorticoid pulse, her immunosuppressive regimen was successively changed to muromonab and tacrolimus with mycophenolate maintenance. Twelve days after transplantation she had abdominal pain and watery/bloody diarrhea. Colonoscopy showed multiple ulcers with mucosal injection and colon edema. A biopsy suggested ischemic cohtis and cytomegalovirus infection was ruled out. Her sjmptoms persisted until mycophenolate was withdrawn and further colonoscopy showed complete resolution. 

Multiorgan damage Drug reaction with eosin-ophilia and systemic symptoms (DRESS) has been attributed to minocycline in a 38-year-old woman and resulted in acute renal failure, transient thyroiditis, raised aminotransferases, and a persistent lymphocytic myocarditis resulting in congestive heart failure plasmapheresis and rituximab were effective after treatment with methylpred-nisolone, mycophenolate, ciclosporin, and muromonab had failed [69" ]. Another case has been reported in a 14-year-old boy [70 ]. 

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