title: Cyclosporine C0- versus C2-monitoring over three years in maintenance heart transplantation.
abstract: BACKGROUND
  There is an ongoing discussion as to whether monitoring of cyclosporine (CsA)-based immunosuppression with plasma levels two hours after medication intake (C2) offers clinical benefit over the measurement of CsA trough levels (C0) in patients after heart transplantation (HTx). In particular, data from long-term maintenance patients are not available.
  
  
  METHODS
  C0 monitoring was performed during 19 months in 65 stable maintenance patients after HTx. During the following 19 months all patients were switched to C2 monitoring. During both periods biopsy proven acute rejections (BPAR), daily CsA dose, plasma creatinine, estimated creatinine clearance and blood pressure values for both periods were analysed.
  
  
  RESULTS
  Data from 65 patients (9.2 ± 3.9 years post HTx) were included. No differences were observed for BPAR ≥2 between C0 (13 pts; 20%) and C2 (12 pts; 18.4%). C2 was associated with lower daily CsA doses (C0 208.7 mg/d vs. C2 182.3 mg/d, p <0.0001) while dose reduction over time was not different during both periods (C0 -13.3 mg/d vs. C2 -22.5 mg/d, p = 0.259). No difference was observed for blood pressure and creatinine clearance.
  
  
  CONCLUSIONS
  In long term maintenance patients C2 monitoring was not associated with immediate beneficial effects on number of rejections, blood pressure levels, and renal parameters. However, patients received lower daily CsA doses.
authors.affiliation: Cardiovascular Center Cardiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. mhermann@gmx.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Hermann
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Fisler
authors.forename: Andreas
authors.initials: A
authors.lastname: Flammer
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
mesh_terms: D000368:Aged; D001706:Biopsy; D003266:Continuity of Patient Care; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008875:Middle Aged; D013557:Switzerland
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine