Results of a three-year prospective study of C2 monitoring in long-term renal transplant recipients receiving cyclosporine microemulsion.
BACKGROUND
The clinical utility of C(2) monitoring of cyclosporine A microemulsion (CsA-ME) was evaluated in a prospective study of 110 patients more than 12 months posttransplant who demonstrated stable graft function and were receiving CsA-ME and steroids.


METHODS
Patients were converted to C(2) monitoring with the CsA-ME dose adjusted to a target C(2) range of 800 to 1,000 ng/mL and followed for 40 + 11 months.


RESULTS
At the time of conversion, 57% of patients exceeded the C(2) target, 20% of patients were below the C(2) target, and 23% of patients were within the C(2) target range. The mean dose of CsA-ME decreased from 258 + 88 to 202 + 76 mg/day (P < 0.0001), and the mean C(2) level decreased from 1,052 + 292 ng/mL to 896 + 233 ng/mL (P < 0.0002). There were no episodes of rejection. At last follow-up, 7.3% of patients had developed chronic renal allograft dysfunction. Use of antihypertensive agents decreased significantly (P = 0.0004), and mean total cholesterol decreased from 6.4 + 1.3 to 5.8 + 1.1 (P = 0.0009) after adoption of C(2) monitoring.


CONCLUSIONS
These findings suggest that conversion of maintenance renal transplant recipients from C(0) to C(2) monitoring of CsA-ME offers the clinical benefits of better control of hypertension and dyslipidemia, with effective protection against chronic renal allograft dysfunction. A target C(2) range of 800 to 1,000 ng/mL in maintenance patients receiving CsA-ME dual therapy seems appropriate.
Citterio
Franco
F
Department of Surgery, Division of Organ Transplantation, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy. fcitterio@rm.unicatt.it
Scatà
Maria Carmela
MC
Romagnoli
Jacopo
J
Nanni
Giuseppe
G
Castagneto
Marco
M
D000328:Adult; D003175:Complement C2 / Q000276:immunology*; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004655:Emulsions / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014180:Transplantation
D003175:Complement C2; D004655:Emulsions; D007166:Immunosuppressive Agents; D016572:Cyclosporine