[Hopeful]

I would be more concerned about his kidneys than an arbitrary trough measurement. I spent a lot of time researching this because my doctors were forever trying to increase my cyclosporine dosage to hit the upper end of the "targeted range". For me and (from what I read) for many pediatric patients, cyclosporine is cleared out of our system at a faster rate than normal. So, the trough is not a reliable indicator of determining the therapeutic range. For example, my trough measurements were always closer to 50-70. It took massive dosages to raise it to 100...more than I could tolerate. Luckily, one of my specialists doesn't believe in troughs (except to check for too much toxicity). He encouraged me to back off to 5 mg/kg/day, which I gladly did.

I've seen reports that talk about the differences in the metabolism of cyclosporine from person to person. They suggest that a 2 hour reading may be a more accurate reading to track than the trough. Unfortunately, nothing has been standardized.

In summary, I would encourage you to pay attention to his kidneys numbers and not go chasing an arbitrary "magic trough number" that was originally established for kidney transplant patients.