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Role of postdose cyclosporine monitoring in living renal transplant recipients
Role of Postdose Cyclosporine Monitoring in Living Renal Transplant Recipients R. Thomas, M. Minz, B. Singh, M. Heer, and R. Kashyap ABSTRACT Achieving optimal cyclosporine (Neoral) absorption is critical for successful graft outcome. Recently there have been studies on postdose monitoring of cyclosporine. Two- and 3-hour postdose cyclosporine levels measured by radioimmunoassay were correlated with occurrence of rejection and cyclosporine nephrotoxicity in 30 patients; C2 and C3 levels were significantly lower than the desired therapeutic levels in patients with acute rejection. Based on our study and those of others we suggest C3 levels should be adopted in clinical practice.
T
HE MEASUREMENT of cyclosporine trough levels has been intrinsic part of the management of transplant patients.1 We correlated the trough (C0), 2-hour, (C2), and 3-hour (C3) postdose cyclosporine levels with the occurrence of acute rejection episodes versus cyclosporine nephrotoxicity after living donor renal transplantation. METHODS Thirty consecutive patients from August 2001 to January 2002 were included in the study. Immunosuppression included cyclosporine microemulsion (ME), azathioprine, and prednisolone. Samples were taken at 0, 2, and 3 hours on Day 5 after transplant. Cyclosporine levels were measured by the CYCLOTracSP radioimmunoassay kit (Incstar Corporation, Stillwater, Minn, USA).
RESULTS
The gender distribution was 29 men and 1 woman. Six of 30 (20%) recipients displayed rejection and 3 of 30 (10%) developed nephrotoxicity upon follow up. The mean C0, C2, and C3 levels in patients with acute rejection were 290.8 ⫾ 17.1, 1103.2 ⫾ 347.8 (P ⬍ .05), 1081.3 ⫾ 192.4 (P ⬍ .05) ng/mL compared to those without rejection 275.7 ⫾ 34.6, 1521.7 ⫾ 294.8 (P ⬍ .05), 1346.6 ⫾ 221.7 (P ⬍ .05) ng/mL, respectively (Fig 1). The mean C0, C2, and C3 levels in patients with cyclosporin nephrotoxicity were 299.0 ⫾ 23.28, 1540 ⫾ 38.4, and 1297.7 ⫾ 90.7 ng/mL compared to those without nephrotoxicity 276.5 ⫾ 32.6, 1426 ⫾ 362, and 1293 ⫾ 250 ng/mL, respectively. On logistic regression analysis only C3 provided a significant predictor of acute rejection (P ⬍ .01) DISCUSSION
In our study, C2 and C3 levels correlated with the occurrence of acute rejection episodes. However there was no
0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.08.108 2104
Fig 1. Mean CsA blood levels in patients with and without rejection.
correlation with trough levels. The Canadian neoral study group2 and Mahalati et al3 have also reported similar results. Based on the present study it appears that postdose monitoring of cyclosporine based on C3 levels should be adopted in clinical practice.
REFERENCES 1. Wingerchuk C, Duthoy KL, Macres MG, et al: Transplant Proc 30:1656, 1998 2. Canadian Neoral Renal Transplantation Study Group: Transplantation 72:1024, 2001. 3. Mahalati K, Belitsky P, West K, et al: Transplant Proc 32:786, 2000 From the Department of Transplant Surgery (R.T., M.M., M.H., R.H.) and the Department of Nuclear Medicine (B.S.), Chandigarh, India. Address reprint requests to Dr M Minz, H.No. 63 Sector 24 Chandigarh, India 160023. E-mail: [email protected]
© 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 36, 2104 (2004)
T
HE MEASUREMENT of cyclosporine trough levels has been intrinsic part of the management of transplant patients.1 We correlated the trough (C0), 2-hour, (C2), and 3-hour (C3) postdose cyclosporine levels with the occurrence of acute rejection episodes versus cyclosporine nephrotoxicity after living donor renal transplantation. METHODS Thirty consecutive patients from August 2001 to January 2002 were included in the study. Immunosuppression included cyclosporine microemulsion (ME), azathioprine, and prednisolone. Samples were taken at 0, 2, and 3 hours on Day 5 after transplant. Cyclosporine levels were measured by the CYCLOTracSP radioimmunoassay kit (Incstar Corporation, Stillwater, Minn, USA).
RESULTS
The gender distribution was 29 men and 1 woman. Six of 30 (20%) recipients displayed rejection and 3 of 30 (10%) developed nephrotoxicity upon follow up. The mean C0, C2, and C3 levels in patients with acute rejection were 290.8 ⫾ 17.1, 1103.2 ⫾ 347.8 (P ⬍ .05), 1081.3 ⫾ 192.4 (P ⬍ .05) ng/mL compared to those without rejection 275.7 ⫾ 34.6, 1521.7 ⫾ 294.8 (P ⬍ .05), 1346.6 ⫾ 221.7 (P ⬍ .05) ng/mL, respectively (Fig 1). The mean C0, C2, and C3 levels in patients with cyclosporin nephrotoxicity were 299.0 ⫾ 23.28, 1540 ⫾ 38.4, and 1297.7 ⫾ 90.7 ng/mL compared to those without nephrotoxicity 276.5 ⫾ 32.6, 1426 ⫾ 362, and 1293 ⫾ 250 ng/mL, respectively. On logistic regression analysis only C3 provided a significant predictor of acute rejection (P ⬍ .01) DISCUSSION
In our study, C2 and C3 levels correlated with the occurrence of acute rejection episodes. However there was no
0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.08.108 2104
Fig 1. Mean CsA blood levels in patients with and without rejection.
correlation with trough levels. The Canadian neoral study group2 and Mahalati et al3 have also reported similar results. Based on the present study it appears that postdose monitoring of cyclosporine based on C3 levels should be adopted in clinical practice.
REFERENCES 1. Wingerchuk C, Duthoy KL, Macres MG, et al: Transplant Proc 30:1656, 1998 2. Canadian Neoral Renal Transplantation Study Group: Transplantation 72:1024, 2001. 3. Mahalati K, Belitsky P, West K, et al: Transplant Proc 32:786, 2000 From the Department of Transplant Surgery (R.T., M.M., M.H., R.H.) and the Department of Nuclear Medicine (B.S.), Chandigarh, India. Address reprint requests to Dr M Minz, H.No. 63 Sector 24 Chandigarh, India 160023. E-mail: [email protected]
© 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 36, 2104 (2004)