| Sub-title | |
| Author | E Farrugia |
| Abstract | Cyclosporin (CsA) dislplays a narrow therapeutic range and a wide intrainterpatient pharmacokinetic variability, particularly in the absorption phase. Low oral biovavailability of CsA is recognised as a significant risk factor for acute transplant rejection and overexposure to CsA increases the risk of chronic allograft nephropathy. Measurement of CsA trough blood level (Co) is currently performed but recently, 2 hours post dose levels (C2) has been proposed as a superior tool for CsA monitoring. The aim of the present study was to analyse the feasibility of introducing C2 monitoring in Malta and to compare the results of both Co and C2. In 40 kidney transplant recipients under the care of one nephrologist (30 cadaveric and 10 living-related) receiving CsA in association with other immunosuppressive drugs, Co + C2 were measured by using a monoclonal specific antibody radiommunoassay. The following results were obtained. 1. C2 monitoring was readily accepted by Maltese transplants receipents and its implementation both in the hospital and out-patient settings went without a hitch. 2. A clear relationship between Co and C2 blood levels was observed. 3. CsA absorption is variable and C2 correlated better with the CsA dose (mg/kg) than Co. 4. Most patients at target Co were not at recommended target C2 concentrations. Conclusion: C2 monitoring better defines the therapeutic range and helps to identify overexposure to CsA, potentially associated with nephrotoxicity. The transplant team is now familiar with C2 target levels with dose adjustments done according to C2 level. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
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| Key words | renal transplant, therapeutic monitoring, transplant rejection, cyclosporin |