Efficacy of Cyclosporine Microemulsion C2 Monitoring in Renal Transplants

Lee, Jeong Hoon; Ha, Jongwon; Kim, Kye Yang; Kim, Sang Joon

Abstract

PURPOSE
In monitoring blood concetration of cyclosporine after transplantation, four-hour under the conentration-time curve (AUC0-4) was reported superior to C0, and C2 was well correlated with AUC0-4. The purpose of this study is to evaluate the validity and usefulness of C2 monitoring compared with C0 monitoring in kidney transplants using cyclosporine microemulsion.
METHODS
From Jan. 2002 to Dec. 2002, twenty primary living donor kidney transpant patients were selected and followed up for 6 months after transplantation. C0 was checked daily for 2 weeks after transplantation then every week for a month, every two week for a month and monthly thereafter. C2 was checked at 1, 7, 14 days after operation then checked every 4, 8, 12, 16, 20, 24 weeks. AUC0-4 was calculated at 1 day, 1 week, 2 week and 6 months after transplantation. Historical control group was made of 20 cosecutive kidney transplants who had had transplanted just before the start of the study. The were monitored according to the C0 level.
RESULTS
CsA absorption kinetics were different that of caucasian data. Twelve patients (63%) at 7th post-operative day and 17 patients (85%) at 14th post-operative day reached Cmax at 2 or 3 hours after ingestion of cyclosporine irrespective of rejection. AUC0-4 was best correlated with C2 levels at 14th post-operative day (R2>0.800). Most of patients did not reach recommended therapeutic level of international consensus. Only one patient had experienced acute rejection after transplantation but three patients had experienced nephrotoxicity after transplantation although they had shown the relatively low levels of AUC0-4 and C2. No statistical differences were found in AUC0-4, C2, and C0 levels compared with patients without rejection.
CONCLUSION
AUC0-4 was better correlated with C2 than C0. There was no statistical difference in the incidence of the acute rejection between C2 group and C0 group. Although AUC0-4, and C2 levels were relatively low, C2 group had shown good renal function. Further study is needed to define optimal guidelines for monitoring C2 and AUC0-4 in korean.