Cyclosporine C2 monitoring improves renal dysfunction after lung transplantation

被引:30
作者
Glanville, AR [1 ]
Morton, JM [1 ]
Aboyoun, CL [1 ]
Plit, ML [1 ]
Malouf, MA [1 ]
机构
[1] St Vincents Hosp, Lung Transplant Unit, Darlinghurst, NSW 2010, Australia
关键词
D O I
10.1016/j.healun.2003.08.032
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Cyclosporine (CyA) toxicity is a potential cause of renal dysfunction, which occurs in 38% of lung transplant (LTx) recipients within 5 years. Reducing CyA to "sub-therapeutic" trough (CO) levels increases the risk of rejection. The 2-hour post-dose concentration (C2) is favored as the,best single-point surrogate measure of CyA area under the curve (AUC), which reflects drug exposure. In this investigation we assess the effect of conversion to CyA C2 monitoring on renal dysfunction after LTx. Methods: Fifteen patients (M:F = 12:3), aged 47 +/- 14 years (range 28 to 62), 3.5 +/- 2.7 (0.2 to 9.0) years post-LTx, with C0 in the therapeutic range (maintenance 100 to 200 mug/liters) (Behring/EMIT immunoassay) and abnormal renal function, were converted from CO monitoring to C2 monitoring with dose reductions targeting C2 levels of 300 to 600 mug/liter over a 12-month period. Results: CyA dose was reduced from 6.4 +/- 7.3 (1.2 to 27.9) to 3.1 +/- 2.7 (0.8 to 9.0) mg/kg/day (p = 0.04), with a reduction in C2 levels-from 799 341 (299 to 1,466) to 390 +/- 148 (195 to 675) mug/liter (p < 0.001). Improvements in serum creatinine (0.20 +/- 0.07 [0.12 to 0.35] vs 0.16 0.04 [0.11 to 0.22] mmol/liter [p = 0.005]) were maintained during the study follow-up period of 1 year. Only 1 patient developed acute rejection and group mean forced expiratory volume in 1 second (FEV1) remained stable (2.4 +/- 1.0 [1.1 to 4.0] vs 2.4 +/- 1.2 [1.1 to 4.6] liters). Conclusions: C2 monitoring is a practical method of improving renal dysfunction that allows safe dose reductions of CyA when formal AUC monitoring is not feasible. Extended use of this strategy is associated with long-term benefits.
引用
收藏
页码:1170 / 1174
页数:5
相关论文
共 35 条
  • [1] Aleksic I, 2000, TRANSPLANTATION, V69, P1586
  • [2] Clinical benefit of monitoring cyclosporine C2 and C4 in long-term liver transplant recipients
    Barakat, O
    Peaston, R
    Rai, R
    Talbot, D
    Manas, D
    [J]. TRANSPLANTATION PROCEEDINGS, 2002, 34 (05) : 1535 - 1537
  • [3] Barama A, 2000, TRANSPLANTATION, V69, pS162
  • [4] Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil
    Barkmann, A
    Nashan, B
    Schmidt, HHJ
    Böker, KHW
    Emmanouilidis, N
    Rosenau, J
    Bahr, MJ
    Hoffmann, MW
    Manns, MP
    Klempnauer, J
    Schlitt, HJ
    [J]. TRANSPLANTATION, 2000, 69 (09) : 1886 - 1890
  • [5] Impact of absorption profiling on efficacy and safety of cyclosporin therapy in transplant recipients
    Belitsky, P
    Dunn, S
    Johnston, A
    Levy, G
    [J]. CLINICAL PHARMACOKINETICS, 2000, 39 (02) : 117 - 125
  • [6] Comparison of neoral dose monitoring with cyclosporine trough levels versus 2-hr postdose levels in stable liver transplant patients
    Cantarovich, M
    Barkun, JS
    Tchervenkov, JI
    Besner, JG
    Aspeslet, L
    Metrakos, P
    [J]. TRANSPLANTATION, 1998, 66 (12) : 1621 - 1627
  • [7] Cantarovich M, 1998, CLIN TRANSPLANT, V12, P243
  • [8] Clinical benefit of neoral dose monitoring with cyclosporine 2-HR post-dose levels compared with trough levels in stable heart transplant patients
    Cantarovich, M
    Elstein, E
    de Varennes, B
    Barkun, JS
    [J]. TRANSPLANTATION, 1999, 68 (12) : 1839 - 1842
  • [9] Conversion and pharmacokinetic studies of a microemulsion formulation of cyclosporine in pediatric liver transplant patients
    DAgostino, D
    Gimenez, M
    Yamaguchi, B
    Glancszpigel, R
    Vinuesa, F
    Gamba, M
    Ciardullo, M
    deSantibanes, E
    [J]. TRANSPLANTATION, 1996, 62 (08) : 1068 - 1071
  • [10] Conversion to rapamycin immunosuppression in renal transplant recipients: Report of an initial experience
    Dominguez, J
    Mahalati, K
    Kiberd, B
    McAlister, VC
    MacDonald, AS
    [J]. TRANSPLANTATION, 2000, 70 (08) : 1244 - 1247