A multicenter, prospective study of C2-monitored cyclosporine microemulsion in a U.S. population of de novo renal transplant recipients.
BACKGROUND
Monitoring cyclosporine microemulsion (CsA-ME; Neoral) exposure 2 hours postdose (C2) has been reported to optimize the efficacy and safety of CsA-ME therapy. The addition of induction therapy to a maintenance regimen including CsA-ME C2 monitoring has not been evaluated.


METHODS
In all, 123 adult renal transplant recipients were recruited at 14 U.S. centers for this 6-month study. CsA-ME dose was to be titrated to attain C2 targets of 1700 and 1500 ng/ml during posttransplant months 1 and 2, respectively. After 2 months, patients were randomized to one of two groups with different, decreasing C2 targets. Basiliximab, mycophenolate mofetil, and corticosteroids completed the study immunosuppression.


RESULTS
Of the 119 evaluable patients, 76% were male, 22% African American, and 66% deceased donor recipients. Biopsy-proven acute rejection occurred in 10 patients (9.3%); there were two failed grafts and one death. Serum creatinine and calculated GFR values suggest good renal function, with month 6 medians of 1.5 ng/ml and 67 ml/min/1.73 m. Safety and tolerability assessments revealed no unexpected outcomes. Observed C2 levels were generally lower than protocol targets, particularly in the first weeks posttransplantation.


CONCLUSIONS
The striking efficacy and outcomes may have been achieved in this study with lower C2 levels of CsA-ME because of the addition of basiliximab induction.
Vincenti
Flavio
F
Department of Surgery, Kidney Transplant Service, University of California at San Francisco, San Francisco, CA 94143-0780, USA. vincentif@surgery.ucsf.edu
Mendez
Robert
R
Curtis
John
J
Light
Jimmy
J
Pearson
Thomas
T
Wu
You-Min
YM
Katz
Stephen M
SM
Akalin
Enver
E
Esterl
Robert
R
Gugliuzza
Kristene
K
Shihab
Fuad
F
Jordan
Stanley
S
Jonsson
Johann
J
Molmenti
Ernesto
E
Barbeito
Ralph
R
D058186:Acute Kidney Injury / Q000209:etiology; D001741:Black or African American; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D004655:Emulsions; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000208:ethnology / Q000401:mortality; D008297:Male; D011153:Population; D014481:United States
D004655:Emulsions; D007166:Immunosuppressive Agents; D016572:Cyclosporine