UKMLA PLAB AMC USMLE Prometric MCQ

Question:
A 60 year old male patient has just had a renal transplant after chronic renal failure secondary to diabetes. He also has a history of celiac disease. He is receiving cyclosporin A as an immunosuppressive agent to reduce the risks of rejection. Which of the following is the most likely complication of Cyclosporin A in this patient?

a) renal impairment
b) heart failure
c) small bowel lymphoma
d) liver failure
e) cholelithiasis

Correct Answer: A

Explanation:

Cyclosporine commonly decreases glomerular filtration rate and raises the serum creatinine. Acute nephrotoxicity may occur with the first perioperative dose of cyclosporine because of drug-induced renal afferent arteriolar vasoconstriction superimposed on chronic renal hypoperfusion from a low cardiac output. Cyclosporine also appears to have dose-dependent toxic effects on the renal tubules and can cause renal tubular acidosis. Cyclosporine has been shown to be an effective prophylactic drug for graft-versus-host disease in allogeneic BMT recipients and has largely replaced methotrexate, which was associated with more liver toxicity. The major toxic effect of cyclosporine is renal. The hepatotoxic effect of cyclosporine is related to blood levels and is thus more predictable than methotrexate toxicity. Metabolic effects of cyclosporine are related to its metabolism in the liver P-450 enzyme system. One of the interesting questions about cyclosporine is whether it can be implicated in the increased incidence of cholelithiasis seen in transplant recipients. Hypertriglyceridemia has also has been reported as a complication of cyclosporine therapy