Efficacy of C0 and C2 monitoring in adult liver transplant recipients treated with neoral, mycophenolate mofetil, and steroids.
BACKGROUND
Adjustment of induction therapy with Neoral after liver transplantation according to C2 levels yields a reduced incidence of rejection compared with C0 monitoring. A combination with mycophenolate mofetil may further reduce episodes of acute rejection. The purpose of this analysis was to evaluate the predictive value of C0 and C2 monitoring and the influence of primary dysfunction in liver transplant recipients receiving induction therapy with Neoral, mycophenolate mofetil, and steroids.


METHODS
One hundred consecutive adult liver transplant recipients were analyzed. Neoral doses were solely adjusted according to C0 target levels in the first week by daily analysis of C0 levels. C2 levels were also measured, but results did not influence the decision process of daily Neoral adjustments.


RESULTS
The 3-month survival rate for all patients was 83%. For a further analysis, 35 patients were excluded, the remaining 65 patients experienced 15 rejections (23.1%). Patients who did reach C0 target levels by days 3, 5, or 7 had rejection rates no different from those who did not reach C0 target levels. The patients who did reach C2 target levels by day 7 showed a significantly lower rejection rate compared with those who did not reach these levels. Comparison of rejection rates among patients with primary function grades I and II versus grades III and IV revealed a significant difference. There was no correlation between Model for End-Stage Liver Disease (MELD) score and acute rejection episodes.


CONCLUSIONS
Achievement of C2 target levels by day 7, especially in the combination of Neoral with mycophenolate mofetil, led to a remarkably low acute rejection rate following liver transplantation.
Treckmann
J
J
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany. j.treckmann@gmx.net
Paul
A
A
Ozcelik
A
A
Saner
F
F
Malagó
M
M
Nadalin
S
S
Lang
H
H
Malamutman
E
E
Gerken
G
G
Broelsch
C E
CE
D000305:Adrenal Cortex Hormones / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000328:Adult; D016572:Cyclosporine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis
D000305:Adrenal Cortex Hormones; D016572:Cyclosporine; D009173:Mycophenolic Acid