Effect of Pantoprazole and Esmoprazole on the Cyclosporine Blood Concentration in a Kidney Transplant Recipient

Abstract

Background and Objective: Renal allograft survival requires multiple immunosuppressive drugs. Which are usually used in combinations of triple therapy among them is calcineurin inhibitor cyclosporine (CsA) that requires continuous drug level monitoring to ensure efficient immunosuppression with minimal adverse effects .This strategy of multiple immunosuppressants may lead to gastric complications that necessitate gastro-protective medications, notably, proton pump inhibitors (PPIs). The simultaneous administration of PPIs with cyclosporine can result in change in CsA concentration that may affect the allografted organ on the long term. This study aimed to compare the influence of pantoprazole and esomeprazole on serum cyclosporine trough levels (C0) in renal transplant recipients (RTR). Methods: A prospective, parallel, open-label trial was conducted on 47 adult RTR receiving; cyclosporine doses adjusted to achieve trough concentrations of 100-150 µg/L, mycophenolate mofetil (MMF) 750 mg q12 hr and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt January – September 2016. Patients were randomized into the esomeprazole group (25) or pantoprazole group (22) receiving an equivalent dose (40 mg once daily). The study outcomes included renal function decline, assessed by elevations in serum creatinine, caused by cyclosporine level variations in either of the two study groups. Renal function, C0 and CBC measurements were measured at baseline and monthly for 6 months. Results: The mean C0 values were higher in the pantoprazole group than in the esomeprazole group in the sixth month only (p = 0.007). Serum creatinine level was lower in the sixth month than at baseline within the esomeprazole group (p = 0.004). There were no signs of rejection biochemical or clinical in any of the study groups. Conclusion: In conclusion PPIs should be used with caution and doses should be titrated to reach the C0 targets in RTR this is of more importance in pantoprazole than esomeprazole; to avoid C0 levels elevation or decline affecting the allograft function.