Optimal C2 Concentration of Cyclosporin Corrected With Good Efficacy and Safety in Asian Kidney Transplant Recipients
Journal
Transplantation Proceedings
Journal Volume
40
Journal Issue
7
Pages
2243-2244
Date Issued
2008
Author(s)
Abstract
Introduction: Calcineurin inhibitors (CNI) are known for their renal toxicity. Lower CNI exposure is a reasonable option to mitigate potential CNI-induced renal toxicity. Herein we have presented our long-term results after lower cyclosporine (CsA) exposure in the first year. Materials and Methods: Between 1997 and 2004, 63 renal transplant recipients received CsA-based immunosuppression. CsA dosing was adjusted according to the 2-hour whole blood concentration (C2) level. We retrospectively reviewed acute rejection and graft survivals rates, as well as whole blood C2 levels. Results: Review of serial mean C2 concentrations at 1, 2, 3, 6, and 12 months after transplantation were 1341, 1241, 1191, 1059, and 927 ng/mL, respectively. These levels were slightly lower than those suggested by the Consensus for C2 levels by Levy et al in 2002, namely, 1600 to 2000 ng/mL (mean, 1700); 1400 to 1600 ng/mL (mean, 1500); 1200 to 1400 ng/mL (mean, 1300); 1000 to 1200 ng/mL (mean, 1100), and 800 to 1000 ng/mL (mean, 900), respectively. Acute rejection rate at 3 months and 1 year are 17.5% and 23.8%. Graft survival at 1 year was 97% and at 5 years, 89%. Two patient were lost to fulminant hepatitis and acute myocardial infarction during the first year, which were not associated with underimmunosuppression. Conclusion: Appropriate CsA C2 levels may be lower among Taiwanese. Our C2 dosing strategy resulted in good outcomes with acceptable side effects in our single-center experience. Appropriate CsA C2 levels for Asians deserve more attention in trials of larger scale; most reference levels are presently concluded from studies of Caucasians. ? 2008 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
azathioprine; cyclosporin A; mycophenolic acid 2 morpholinoethyl ester; steroid; corticosteroid; cyclosporin; drug derivative; immunosuppressive agent; mycophenolic acid; mycophenolic acid 2 morpholinoethyl ester; adult; article; Asian; controlled study; disease association; drug blood level; drug efficacy; drug safety; female; graft recipient; graft rejection; graft survival; heart infarction; hepatitis; human; human tissue; immunosuppressive treatment; kidney transplantation; major clinical study; male; priority journal; blood; follow up; immunology; middle aged; retrospective study; safety; time; Adrenal Cortex Hormones; Adult; Asian Continental Ancestry Group; Azathioprine; Cyclosporine; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Retrospective Studies; Safety; Time Factors
Type
journal article