Monitoring of cyclosporine 2-hour post-dose levels in heart transplantation: Improvement in clinical outcomes

Background: Cyclosporine 2-hour post-dose (C2) monitoring is. predictive of outcomes in solid-organ transplants. The purpose of this study was to determine C2 levels at various time points after heart transplantation and determine whether trough ( CO) or C2 better predicts clinical outcomes. Methods: This was a 2-phase prospective study with paired determinations of cyclosporine levels at CO and C2 in 58 heart transplant patients (46 men; mean-age, 56 years). Phase I (6-month follow-up): cyclosporine monitored according to C0 levels (C2 blinded). Phase II (6-month follow-up): cyclosporine monitored according to C2 levels (C0 blinded). Clinical outcomes assessed were severe infections,. rejection score, and renal dysfunction. Results: No differences were observed in renal function between the phases. In Phase 1, 8 infections (4 severe) and in Phase 11, 6 infections (2 severe) were detected. During Phase 1, the CO levels did not correlate (p = .96) with the presence (195 +/- 121 ng/ml) or not (197 +/- 100 ng/ml) of rejection. During Phase II, CO levels did, not correlate (p = .88) with the presence (204 +/- 85 ng/ml) or not (209 138 ngln-A) of rejection. During Phase 1, C2. levels did correlate (p = 0.022) with the presence (777 +/- 326 ng/ml) or not (1,015 +/- 422 ng/ml) of rejection. During Phase II, higher C2 levels showed a significant correlation (p = 0.63) with no rejection (967 470 ng/ml vs 765 297 ng/ml, no rejection vs rejection, respectively). Conclusion: High C2 levels were associated with less episodes of acute cellular rejection in patients post-heart transplantation. Monitoring with C2 levels is feasible and safe in terms of preservation of renal function and infection rates.