title: Relationship between endomyocardial biopsy score and cyclosporine 2-h post-dose levels (C) in heart transplant patients receiving anti-thymocyte globulin induction.
abstract: BACKGROUND
  Cyclosporine (CsA) 2-h post-dose levels (C(2)) correlate better with the area-under-the-curve compared with trough levels. The purpose of this study was to determine the relationship between C(2) and endomyocardial biopsy (EMB) score in heart transplant patients receiving anti-thymocyte globulin (ATG)-induction.
  
  
  METHODS
  We reviewed 517 EMB performed during the first year in 39 adult heart transplant patients receiving ATG-induction, corticosteroids, mycophenolate mofetil and CsA. C(2) obtained on the day of EMB was related to the International Society for Heart and Lung Transplantation classification (score </=2 or >/=3A). Furthermore, EMB were related to C(2) (ng/mL), sorted according to the lower recommended range in liver (0-3 months: 850; 4-6 months: 700; 7-12 months: 500) or renal transplantation (0-1 month: 1500; 2-3 months: 1200; 4-6 months: 1000; 7-12 months: 800).
  
  
  RESULTS
  Overall, C(2) did not significantly differ in patients with EMB </=2 or >/=3A. However, during the first month, EMB </=2 was associated with a trend towards a higher mean C(2) compared with EMB >/=3A (750 ng/mL vs. 530 ng/mL). When C(2) were sorted according to the lower recommended range in liver or renal transplantation, no significant difference was observed when EMB was </=2 or >/=3A.
  
  
  CONCLUSIONS
  In heart transplant patients receiving ATG-induction, C(2) did not significantly differ according to EMB </=2 or >/=3A. No significant relationship was found between EMB score and C(2) based on the lower recommended range in liver or renal transplantation. However, mean C(2) >750 ng/mL appears to be associated with a lower rejection score during the first month.
authors.affiliation: Department of Medicine, Division of Transplantation, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
authors.forename: Nadia
authors.initials: N
authors.lastname: Giannetti
authors.forename: Renzo
authors.initials: R
authors.lastname: Cecere
mesh_terms: D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D001707:Biopsy, Needle; D016572:Cyclosporine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004699:Endocardium / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D009206:Myocardium / Q000473:pathology*
chemical_list: D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid