title: The relative importance of cyclosporine exposure in heart, kidney or liver transplant recipients on maintenance therapy.
abstract: We investigated the relationship between cyclosporine exposure and the presence of cyclosporine-related side effects and assessed the advantage of the cyclosporine concentration 2 h post-dose (C(2)) over pre-dose concentration (C(0)) monitoring. Cyclosporine area-under-the-concentration-time curves were measured during the absorption phase (AUC(0-4 h)) in 49 liver, 28 heart and 26 kidney transplant recipients (time since transplantation >6 years) with or without cyclosporine-related side effects on maintenance therapy. The cyclosporine C(0) correlated well with AUC(0-4) (r=0.77), whereas C(2) levels correlated strongly with AUC(0-4) (r=0.92). Although we observed a trend towards higher CsA concentrations in transplant recipients with side effects than in patients without CsA toxicity, the large majority of those differences were not statistically significant. Thus, as cyclosporine exposure was not clearly related to the presence of side effects, and C(0) correlated fairly with AUC(0-4), the advantage of monitoring cyclosporine treatment using C(2) rather than C(0), may be limited for patients on cyclosporine maintenance therapy.
authors.affiliation: Department of Internal Medicine, Renal Transplant Unit, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 DR, Rotterdam, The Netherlands. d.a.hesselink@erasmusmc.nl
authors.forename: D A
authors.initials: DA
authors.lastname: Hesselink
authors.forename: T
authors.initials: T
authors.lastname: van Dam
authors.forename: H J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: A H M M
authors.initials: AH
authors.lastname: Balk
authors.forename: R A A
authors.initials: RA
authors.lastname: Mathôt
authors.forename: P J H
authors.initials: PJ
authors.lastname: Smak Gregoor
authors.forename: W
authors.initials: W
authors.lastname: Weimar
authors.forename: T
authors.initials: T
authors.lastname: van Gelder
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine