Cyclosporine (Cya) monitoring with pre-dose (C0) levels is a poor indicator of the area under the concentration-time curve in the first four hours after administration. Cyclosporine monitoring using the 2 hours postdose sample (C2) is a better predictor of toxicity and rejection.
To analyze the short-term effects produced by the adoption of C2 monitoring in stable liver transplant patients (p).
Patients and method:
C2 monitoring was adopted in 47 p that underwent liver transplantation since July 1995 to December 2002. Mean age : 44+14.15 years old. Sex: female 63.8%(30p), male 36.2%(17p). Mean time after transplantation: 46.29 months (m) (77%, > 12 m.; 11%, 6 to 12 m. and 13%, <6 m). Etiology: fulminant hepatic failure 19.1% (9p), cirrhosis 80.9% (38p). Complications: hypercholesterolemia 15p(31.25%), hypertension: 12p(25.53%), renal dysfunction (creatinine > 1.20 mgr/dl) 6p (12.5%), diabetes 1p, (2.12%). The following data were analyzed: C0, C2 before adoption of C2 monitoring, C2 after 3 m. of C2 monitoring adoption as well as the doses that correspond with each monitoring.
The following parameters were analysed comparatively: creatinine, glycaemia, cholesterol and blood pressure before adopting C2 and after 3 m. of C2 monitoring. Optimum C2 were pre-determined: 0-6m., 1000 ngr/ml; 6-12 m., 800 ngr/ml; > 12 m., 600 ngr/ml. C2 was measured by monoclonal fluorescence polarization immunoassay method.
At the point at C2 monitoring was adopted, mean C0 was 191 ngr/mL, and mean C2 was 904 ngr/mL There was no coincidence between initial C2 monitoring and C2 predetermined values in 59.57% (28p), 75% of this p (21/28) were found to have C2 levels exceeding target. There was a significant reduction in the mean dose of Cya after 3 m. of C2 monitoring (200+81.26 mgr/ day to 150+73.38 mgr/day). Doses were reduced in 43.75% of p. The mean rate of reduction was 33.31% (16.66% to 60%).
There was a significant reduction of cholesterol levels, p=0,01 (208+53.24mgr/dl to 191+47.42mgr/dl). 80% of p.(12/15p) showed at least 10 mgr/dl of reduction, 40% (6/15p) achieved cholesterol values < 220 mgr/dl. Although there was not a significant reduction in creatinine levels, p=0,82 (0,99+0.28 mgr/dl to 1,03+0.27mgr/dl), 4 of 6 p with creatinine values > 1.20 mgr/dl achieved creatine values <1.20 mgr/dl. There was no significant changes in hypertension treatment and glycaemia, p=0,07 (0.87+0.12 g/l to 0.90+0.14g/l). All patients remained free of rejections.
The adoption of C2 monitoring lead us to reduce Cya doses in 43.75% of p without any episode of rejections. There was a significant reduction in cholesterol levels. However there were no significant changes in creatinine, glycaemia and blood pressure values; significant advantages are found with C2 monitoring including a reduction in postransplant managment costs.