title: Experience with cyclosporine: approaching the therapeutic window for C2 levels in maintenance kidney transplant recipients.
abstract: This study was aimed to evaluate the clinical benefit of C2 monitoring in 191 stable renal transplant patients previously monitored by C0. All patients had been transplanted for at least 1 year and received cyclosporine (CsA)-based immunosuppression since the start. At the inceptions C0 levels were significantly correlated with C2 values (P<.0001). Patients with starting C2 levels >1000 ng/mL showed significantly higher levels of serum creatinine (sCr) both at inception (1.66 +/- 0.50 vs 1.44 +/- 0.41 mg/dL; P=.0021) and at the end of a 2-year follow-up (1.84 +/- 0.80 vs 1.46 +/- 0.51 mg/dL; P=.005). C2 monitoring revealed that a high percentage of patients were overexposed to CsA, mainly in the subgroup with most recent renal engraftments (12 to 24 months). The switch to C2 monitoring was associated with a slower deterioration of graft function (P=.02). Further, the mean values of C2 over a 2-year follow-up were inversely correlated with sCr at the end of follow-up (P=.0005). Finally, patients with mean threshold C2 levels above 720 ng/mL, roughly corresponding to the median value of C2, showed significantly lower levels of sCr at the end of follow-up (P=.0004). In conclusion, C2 monitoring of maintenance renal transplant patients allows one to identify a significant percentage of overexposed subjects, possibly limiting the rate of progression of chronic graft dysfunction. Target range values between 700 and 900 ng/mL appear to be associated with better long-term kidney graft function.
authors.affiliation: Department of Emergency and Organ Transplants, Division of Nephrology, University of Bari, Bari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Di Paolo
authors.forename: A
authors.initials: A
authors.lastname: Teutonico
authors.forename: B
authors.initials: B
authors.lastname: Infante
authors.forename: G
authors.initials: G
authors.lastname: Stallone
authors.forename: A
authors.initials: A
authors.lastname: Schena
authors.forename: G
authors.initials: G
authors.lastname: Grandaliano
authors.forename: M
authors.initials: M
authors.lastname: Battaglia
authors.forename: P
authors.initials: P
authors.lastname: Di Tonno
authors.forename: F P
authors.initials: FP
authors.lastname: Schena
mesh_terms: D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality / Q000502:physiology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine