Results of a three-year prospective study of c2 monitoring in long-term renal transplant recipients receiving cyclosporine microemulsion.

摘要

BACKGROUND.: The clinical utility of C2 monitoring of cyclosporine A microemulsion (CsA-ME) was evaluated in a prospective study of 110 patients more than 12 months posttransplant who demonstrated stable graft function and were receiving CsA-ME and steroids. METHODS.: Patients were converted to C2 monitoring with the CsA-ME dose adjusted to a target C2 range of 800 to 1,000 ng/mL and followed for 40+11 months. RESULTS.: At the time of conversion, 57% of patients exceeded the C2 target, 20% of patients were below the C2 target, and 23% of patients were within the C2 target range. The mean dose of CsA-ME decreased from 258+88 to 202+76 mg/day (P<0.0001), and the mean C2 level decreased from 1,052+292 ng/mL to 896+233 ng/mL (P<0.0002). There were no episodes of rejection. At last follow-up, 7.3% of patients had developed chronic renal allograft dysfunction. Use of antihypertensive agents decreased significantly (P=0.0004), and mean total cholesterol decreased from 6.4+1.3 to 5.8+1.1 (P=0.0009) after adoption of C2 monitoring. CONCLUSION.: These findings suggest that conversion of maintenance renal transplant recipients from C0 to C2 monitoring of CsA-ME offers the clinical benefits of better control of hypertension and dyslipidemia, with effective protection against chronic renal allograft dysfunction. A target C2 range of 800 to 1,000 ng/mL in maintenance patients receiving CsA-ME dual therapy seems appropriate.