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  • 1
    ISSN: 1432-2277
    Keywords: Key words Cyclosporin ; conversion ; liver transplantation ; Conversion ; cyclosporin ; liver transplantation ; Liver transplantation ; conversion ; cyclosporin ; Pediatric liver transplantation ; pharmacokinetics ; Pharmacokinetics ; pediatric liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Absorption of cyclosporin from the microemulsion formulation Neoral is less variable than from Sandimmun. Because of a lack of data in pediatric liver transplant recipients, the pharmacokinetic profiles with Sandimmun and Neoral were compared in a conversion study. Thirty-eight children with stable graft function were converted 2–12.3 years post-transplant at a 1:1 ratio. The trough-level (Cmin) with Neoral was 123 ± 39 ng/ml versus 134 ± 29 ng/ml with Sandimmun (P = NS), the area under the time-concentration curve (AUC) was 3325 ± 1125 ng*h/ml versus 2423 ± 846 ng*h/ml (P 〈 0.001), the peak concentration (Cmax) was 650 ± 280 ng/ml versus 337 ± 142 ng/ml (P 〈 0.001), and the median time to Cmax was 2 h (range 0.5–3 h) versus 4 h (range 1–8 h; P 〈 0.05). The weak correlation between Cmin and AUC with Sandimmun (r = 0.5; P = NS) was improved by using Neoral (r = 0.7; P 〈 0.001). The best predictor of AUC was the 2-h concentration (C2 h) of Neoral (r = 0.9; P 〈 0.001). Increased absorption and a more predictable pharmacokinetic profile with Neoral permit safer therapeutic monitoring in children. The exclusive measurement of Neoral-C2 h allows one to estimate drug exposure with high precision ( 〉 90 %).
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-198X
    Keywords: Continuous arteriovenous haemofiltration ; Acute renal failure ; Cardiac surgery ; Liver failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report 24 children with acute renal failure treated with continuous arteriovenous haemofiltration (CAVH) between 1987 and 1991. The median age was 2.9 years (range 3 days to 9 years). The main causes of the acute renal failure were: open heart surgery (n=11) and liver failure of different origins before and after liver transplantation (n=10). The indication for CAVH was oliguria or fluid overload in all children. The femoral vessels were used as vascular access in most instances. Different filters were used, depending on the size of the patient and an average ultrafiltration of 130±89 ml/h was achieved, which resulted in a fluid clearance of 4.0±2.6 ml/min per 1.73 m2. In 18 patients uraemia was adequately controlled. Nine children survived after recovery of their renal function; 15 (62.5%) died as a consequence of multiorgan failure. We conclude that CAVH is an effective method to support critically ill children with acute renal failure.
    Type of Medium: Electronic Resource
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