The value of C2 monitoring in stable renal allograft recipients on maintenance immunosuppression
| Autor: | Johannes Waiser, Ingrid Mai, Hans-Hellmut Neumayer, Lutz Fritsche, Torsten Slowinski, Klemens Budde, Gunilla Einecke |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Time Factors medicine.medical_treatment Gastroenterology Nephrotoxicity Therapeutic index Pharmacokinetics Internal medicine Cyclosporin a Ambulatory Care medicine Humans Aged Transplantation medicine.diagnostic_test business.industry Middle Aged medicine.disease Ciclosporin Kidney Transplantation Survival Analysis Surgery Treatment Outcome Nephrology Therapeutic drug monitoring Cyclosporine Feasibility Studies Female Hemodialysis Drug Monitoring business Immunosuppressive Agents Kidney disease medicine.drug |
| Zdroj: | Nephrology Dialysis Transplantation. 19:215-222 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfg434 |
| Popis: | Background. Cyclosporin A (CyA) is a drug with a narrow therapeutic window and highly variable pharmacokinetics. Therapeutic drug monitoring is essential and conventionally has been guided by trough levels (C 0 ). Recent evidence indicates that a single blood concentration measurement 2 h after CyA administration (C 2 ) is a more accurate predictor of drug exposure and clinical events than determination of C 0 . To date, limited prospective data are available with respect to risks and benefits of C 2 monitoring in renal transplant recipients, and little experience exists with C 2 monitoring in maintenance patients. Methods. In 127 long-term renal allograft recipients, we determined C 2 levels in addition to conventional C 0 and observed clinical outcome over a period of 13.6 ± 3.1 months. To determine the precision of monitoring, we repeatedly determined C 0 and C 2 levels in 46 stable patients without dose change. Results. Clinical outcome was excellent (patient survival 100%, graft survival 97%), with only two borderline rejections, although C 2 levels (564 ± 186 ng/ml) were lower than recommended so far for maintenance patients. We found no significant differences in C 2 levels between patients with rejection and CyA toxicity. Receiver operating characteristic (ROC) analysis showed no prediction for risk of rejection, toxicity or infection by C 2 levels. Repeated determinations of both C 0 and C 2 levels in 46 patients revealed a high intra-patient variability. In these patients, the coefficient of variation for C 2 was only marginally better compared with C 0 . Conclusions. We conclude that in maintenance patients, C 2 concentrations between 500 and 600 ng/ml are well tolerated and provide effective and safe rejection prophylaxis. Although mean C 2 levels do not seem to be helpful in identifying patients at risk for rejection, they may be useful to detect over-immunosuppression and to improve long-term allograft survival further by reducing CyA nephrotoxicity. |
| Databáze: | OpenAIRE |
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