title: Monitoring of cyclosporine levels in transplant recipients using self-administered fingerprick sampling.
abstract: Use of C(2) monitoring for cyclosporine A (CsA) microemulsion results in improved clinical outcomes vs. trough (C(0)) monitoring. Logistical issues include accurate timing of the C(2) sample; requirement for sample dilution with most standard assay techniques; and inconvenience for patients. Recently, it has been shown that CsA concentrations in capillary blood correlate closely with levels in venepuncture samples, and that liquid chromatography tandem mass spectrometry (LC-MS/MS) can analyse CsA concentration using undiluted capillary blood from fingerprick samples. In a study to assess the feasibility of CsA monitoring, 52 stable heart transplant patients were provided with kits to take fingerprick trough and C(2) blood samples at home, returning them to the laboratory by post for LC-MS/MS analysis. In total, 225 samples were provided, of which 14 (6%) were unsuitable for analysis because of clotting (n = 10) or insufficient volume (n = 4). Discomfort was not a problem and initial difficulties that some patients reported in taking the samples resolved with experience. All samples were returned by the postal system in a timely manner. Use of fingerprick assays could allow transplant physicians to have access to C(2) levels when patients visit the clinic for review, and avoids the need for patients to attend the clinic or local healthcare centre solely for venepuncture. A barrier to more widespread introduction of fingerprick testing is likely to be lack of suitable MS facilities and trained personnel. In conclusion, self-administered fingerprick testing for CsA blood levels is practical to implement and highly convenient for patients and offers advantages for the transplant team.
authors.affiliation: Transplant Unit, Wythenshawe Hospital, Manchester, UK. Nizar.Yonan@smuht.nwest.nhs.uk
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
authors.forename: Ruth
authors.initials: R
authors.lastname: Martyszczuk
authors.forename: Ali
authors.initials: A
authors.lastname: Machaal
authors.forename: Anna
authors.initials: A
authors.lastname: Baynes
authors.forename: Brian G
authors.initials: BG
authors.lastname: Keevil
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods; D016572:Cyclosporine / Q000097:blood* / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D005385:Fingers / Q000098:blood supply; D016027:Heart Transplantation / Q000276:immunology / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use; D012648:Self Care
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine