title: Clinical benefits of neoral C2 monitoring in the long-term management of renal transplant recipients.
abstract: BACKGROUND
  Cyclosporine monitoring using the 2-hr postdose sample, C2, has been shown to have advantages in monitoring de novo renal transplant recipients. The purpose of this study was to assess cyclosporine exposure, using C2, in stable renal transplant patients previously monitored by C0 to determine the effect of dose reduction on patients with C2 more than 10% above target and the course of those with C2 at and more than 10% below target, whose dose was not modified.
  
  
  METHODS
  One hundred and seventy-five patients, three or more months after transplantation, had C2 assessed. The relationship of C2 to C0 and of both to renal function was analyzed by linear regression. Blood pressure, serum creatinine level, and lipids were followed for a mean of 15+/-2.6 months.
  
  
  RESULTS
  Eighty-five patients had values more than 10% above target, 42 were within 10% of target, and 48 were more than 10% below target. Cyclosporine dose was reduced in all patients above target. In this group, serum creatinine level was stable overall, but fell significantly in 46 (54%) of 85 from 153+/-55 to 132+/-49 microM. Blood pressure also fell in that group from 135/82 to 131/77. Serum creatinine level was stable in the remaining two groups of patients.
  
  
  CONCLUSIONS
  These data suggest that dose reduction in many overexposed patients leads to improvements in renal function and blood pressure. Further study is required to confirm the long-term benefits of this strategy.
authors.affiliation: Renal Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. edward.cole@uhn.on.ca
authors.forename: Edward
authors.initials: E
authors.lastname: Cole
authors.forename: Nava
authors.initials: N
authors.lastname: Maham
authors.forename: Carl
authors.initials: C
authors.lastname: Cardella
authors.forename: Daniel
authors.initials: D
authors.lastname: Cattran
authors.forename: Stanley
authors.initials: S
authors.lastname: Fenton
authors.forename: Jayne
authors.initials: J
authors.lastname: Hamel
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Grady
authors.forename: Robert
authors.initials: R
authors.lastname: Smith
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D007518:Isoantibodies; D008055:Lipids; D016572:Cyclosporine; D003404:Creatinine