A COMPARISON OF C0 AND C2 MONITORING IN RENAL TRANSPLANT PATIENTS

Abstract

A78 Aims: To compare the effects of Cyclosporine (CyA) C0 and C2 level monitoring on acute rejection (AR) and infection rates, toxicity and graft survival in patients with renal transplant (tx). Methods: Prospectively evaluated 10 patients with C2 monitoring (Group C2) were compared to a group of 10 patients with C0 monitoring (Group C0). In C2 Group, C0 levels were also recorded but drug doses were adjusted according to C2 levels. CyA doses, C0 and C2 blood levels, AR and infection rates, drug toxicity and relation of these to drug levels, creatinine levels, GFR, blood pressures (BP), serum glucose, lipids, liver function tests, and Hct levels were analysed in 5 time periods (≤1 month, >1-≤3 month, >3- ≤6 months, >6-≤12 months, >12-≤18 months post-tx). Results: Two groups were similar in mean age, sex, donor type and antilymphocyte treatment. Delayed graft function was seen in 1 patient in Group C0. 2 patients in GroupC0 and 1 patient in Goup C2 returned to hemodialysis during the study. All patients had at least 6 months’ follow-up, 14 patients completed the study. CyA beginning dose was 8 mg/kg/day in all patients. Adjusted drug doses of patients in Group C2 were higher than the doses in Group C0 in all time periods; the differences were significant in the first and last time periods (6.34 mg/kg and 4.47 mg/kg in first period and 3.1 mg/kg and 1.7 mg/kg in last period, p<0.05). C0 levels were similar in the two groups in all time periods. Mean creatinine levels were lower in Group C2 throughout the study; the differences between the groups were significant in the first and last time periods (1.12 mg/dl and 1.80 mg/dl in first and 1.05 mg/dl and 1.74 mg/dl in last time period, p<0.05). GFR was higher in Group C2, the differences were significant in the first and 4th periods (p<0.05). Transient nephrotoxicity was seen in 1 patient in each group. Transient hepatotoxicity was seen in 1 patient in Group C2. Mean systolic BP and mean diastolic BP were lower in Goup C2 in 1st and 4th periods, respectively (p<0.05). Infection rate was significantly higher in Group C0 in the 3rd period. No significant relation was found between C0 or C2 levels and infection rates in any time period. AR was seen in 3 patients in Group C0 and 2 patients in Group 2. No significant differences in the other parameters analysed were found between the groups. Conclusions: C2 monitoring results in better graft function with similar adverse effects when compared to C0 monitoring in renal transplant patients.