Identifying cyclosporine blood levels associated with the prevention of renal transplant rejection: A single-center, randomized prospective study

Abstract

Multiple-drug therapy may allow reduced individual drug doses with fewer side effects. Blood levels of cyclosporine (CsA) necessary to avoid rejection may vary with different drug combinations. Fifty-eight kidney transplant patients were randomized into two groups: 25 subjects were assigned to the 4-hour area under the curve (AUC 0–4) Cohort—the “high arm” (4500 to 5500 ng · h/mL)—1 and 33 to the AUC 0–4 “low arm” (2400 to 3400 ng · h/mL). After CsA introduction, AUC 0–4 was drawn on days 4, 7, 14, 21, 28, 42, 56, 70, 84, 90. We compared the proportion of rejection versus rejection-free patients, according to the CsA exposure. Logistic regression analysis showed that an AUC 0–4 of ≥4000 ng · h/mL or a 2-hour cyclosporine level (C 2) of ≥1450 ng/mL predicted a rejection-free course among patients not receiving induction therapy. When either basiliximab or thymoglobulin was administered, a C 2 and AUC 0–4 of 1043 ± 151 ng/mL or 3146 ± 262 ng · h/mL, respectively, were associated with a rejection-free course. Our findings confirm the need for different CsA levels to prevent rejection according to induction therapy. Induction with either basiliximab or thymoglobulin allows reduced CsA levels during the first 3 months after renal transplantation.