Malnutrition has hazardous effects in renal transplant recipients (RTRs). We evaluated the impact of serum trough cyclosporine A (CsA) levels (C₀) on outcomes after renal transplantation in malnourished RTRs.
Methods: In total, 123 RTRs were included. Demographic, clinical, and laboratory data were obtained from hospital records retrospectively. The body mass index (BMI) for each recipient’s first year posttransplantation were calculated; group 1: BMI <18.5 kg/m² (n=19), group 2: BMI >=18.5 kg/m² (n=104). All patients received a regimen of prednisone, CsA and azathioprine /mycophenolate mofetil. In 1st post-transplant year, C₀ was significantly lower in group 1 than in group 2 (p:.03). Five-year chronic rejection (CR) rate was significantly higher (63.2% vs 26.0%, p: .003) in group 1 than in group 2. In univarite regression analysis, low C₀ (OR: 0.991, 95% CI: 0.986-0.997, p: .002) and low BMI (OR: 0.205, 95% CI: 0.073-0.573, p: .003) were associated with increased risk of CR. In multivariate analysis, C₀ (OR: 0.993, 95% CI: 0.987-0.999, p: .039) and BMI (OR: 0.821, 95% CI: 0.696-0.968, p: .019) were related with CR. Conclusion: inadequate CsA exposure predisposes to CR and strict adjustment of CsA dosing to achieve desired laboratory ranges is essential to decrease CR rate in malnourished RTRs.