Long-Term Comparative Results of C₀ and C₂ Monitoring of CyA in Renal Transplanted Patients

Abstract

The purpose of this study was to evaluate the effects of CyA monitoring using Co monitoring (fasting level after 12 h from last dose), and C₂ monitoring (2 h after morning dose) on renal functions, lipid levels, CyA levels, and daily dosages of CyA in renal transplanted patients in the posttransplant period from the first month to the 36th month. In our center between 1992–2003, 37 of the 54 renal transplanted patients were treated with CyA, prednisolone, and mycophenolate mofetil or azathioprine. The mean age was 32.36 ± 10.32 and 35.00 ± 10.23 (p = 0.39) in Co (M/F: 18/7) and in C₂ (9/3), respectively. Cadaveric donor (d), living related d, and living unrelated d were in four patients (p), 17 p and four p in Co, and two p, seven p, and three p in C₂, respectively (p = 0.79). Chronic allograft nephropathy (CAN) developed in 13 p (52%) and one p (8.3%) in Co and in C₂, respectively (p = 0.013). Creatinine clearance values were 72.31 ± 23.10 mL/min and 78.73 ± 22.42 mL/min (p:0.621) at first month, 64.97 ± 22.58 mL/min and 78.00 ± 19.90 mL/min (p:0.065) at sixth month, 56.50 ± 19.62 mL/min and 76.62 ± 21.06 mL/min (p:0.006) at 12th month, 50.28 ± 24.79 mL/min and 80.87 ± 18.24 mL/min (p< 0.001) at 24th month, and 55.15 ± 19.21 mL/min and 86.65 ± 14.97 mL/min (p:0.004) at 36th month in C₀ and C₂, respectively. The mean daily dosages of CyA were 354.35 ± 122.63 and 266.67 ± 64.95 mg/d (p:0.031) at first month, 277.17 ± 77.94 and 250.00 ± 73.31 mg/d (p:0.228) at sixth month, 247.92 ± 58.48 and 211.36 ± 62.61 mg/d (p:0.09) at 12th month, 232.95 ± 56.90 and 170.45 ± 41.56 mg/d (p:0.003) at 24th month, and 240.63 ± 52.34 and 153.57 ± 46.61 mg/d (p:0.002) at 36th month in C₀ and C₂, respectively. In C₂, systolic and diastolic blood pressure, uric acid, total cholesterol (C), LDL-C, and triglyceride levels were lower than those monitored with C₀. In C₂, HDL-C levels were also higher than those monitored with C₀. None of these patients returned to dialysis or died in this period. In conclusion, during the first 36 months with monitoring C₂, preservation of renal function, control of blood pressure serum lipids and uric acid were better than those with monitoring C₀. In addition, daily dose of CyA was lower in C₂ method and, at the same time, this effect of C₂ can be accepted as cost effective.

• renal transplantation
• cyclosporine
• C₀-C₂ monitoring