Conversion to C2 monitoring of cyclosporine A exposure in maintenance kidney transplant recipients: results at 3 years.
BACKGROUND
It has been suggested that conversion from monitoring cyclosporine A (CsA) trough level to the level 2 hours after the morning dose (C2 ) may have clinical benefits in maintenance adult renal transplant recipients, but evidence supporting such a suggestion presently is very limited.


METHODS
We enrolled 188 maintenance patients to investigate the clinical impact of the adjustment of CsA dose according to C2 levels over 3 years (target, 800 ng/mL).


RESULTS
Patient and graft survival rates were 100% and 98.4%, respectively. C2 monitoring led to a reduction in CsA dose in 49.4% of patients and an increase in more than 20% of patients without an increase in acute rejection risk and clinically overt nephrotoxicity. Patients in the greatest quartile of C2 levels showed the lowest serum creatinine levels (P = 0.009), the greatest creatinine clearance values (P = 0.0006), and the lowest prevalence of chronic allograft nephropathy (P = 0.01). By means of multivariate analysis, C2 levels were the most relevant independent predictors of graft deterioration (change in serum creatinine level from baseline to end of study > or =0.5 mg/dL [> or =44 micromol/L]). Receiver operating characteristic analysis showed an inflection point of mean C2 level versus risk for graft deterioration at less than 661 ng/mL.


CONCLUSIONS
In maintenance renal transplant recipients, conversion to C2 monitoring is a seemingly safe option with good graft performance after 3 years. Mean C2 levels greater than 661 ng/mL seem to be associated with better long-term graft function and a lower prevalence of biopsy-proven chronic allograft nephropathy, at least during a 3-year follow-up.
Di Paolo
Salvatore
S
Department of Emergency and Organ Transplantation, Division of Nephrology, University of Bari, Policlinico, Bari, Italy. s.dipaolo@nephro.uniba.it
Teutonico
Annalisa
A
Schena
Antonio
A
Infante
Barbara
B
Stallone
Giovanni
G
Grandaliano
Giuseppe
G
Ditonno
Pasquale
P
Battaglia
Michele
M
Schena
Francesco Paolo
FP
D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000473:pathology / Q000502:physiology; D019520:Living Donors; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D013995:Time
D016572:Cyclosporine