Validity of C2 Monitoring of Microemulsion Cyclosporine in Early Renal Transplant Period

Lee, Jong Hoon; Kim, Myoung Soo; Kwon, Ki Hwan; Kim, Bong Soo; Huh, Kyu Ha; Kim, Soo Hyon; Kim, Hae Jin; Jeon, Kyung Ock; Kim, Hyun Jung; Kim, Soon Il; Kim, Yu Seun; Park, Ki Il

Abstract

PURPOSE: Four-hour area under the concentration-time curve (AUC0-4) was considered to be superior rather than C0 in predicting the development of acute rejection, and was reported most well correlated with C2 in post-transplant period. The purpose of this study was to demonstrate the correlation between AUC0-4 and each C0,1,2,3,4, and to compare C2 with C0 in predicting acute rejection in de-novo kidney recipients.
METHODS
Fifty- six adult living donor kidney transplants were followed up 3 months after transplantation. Cyclosporine A (CsA) dose was adjusted with C0. AUC0-4 was measured on 5th and 19th post-operative day, and C2 as well as C0 was measured on post-operative 5, 12, 19, 30, 60, 90 days.
RESULTS
Fifteen patients (26.8%) experienced acute rejection 12.0+/-10.9 (5~48) days after transplantation. CsA absorption pharmacokinetics was different with data based on Caucasian recipients. In more than 60% of patients, peak concentration (Cmax) was reached 2 hours after oral intake of CsA regardless the occurrence of acute rejection and postoperative days. AUC0-4 was most critically correlated with C2 on 5th and 19th post-operative days (R2>0.800, respectively). Recipients having acute rejection between 5th and 7th post-operative day, had statistically lowered AUC0-4, C2, C3 (P<0.05) compared with patients without acute rejection.
CONCLUSION
In early post-transplant days, AUC0-4 was powerfully correlated with C2. Monitoring of C2 rather than C0 could predict the occurrence of acute rejection in this period. Value of C2 monitoring in Koreans beyond 7th day awaits further study by adjusting CsA dose with C2 rather than C0.