Three-years experience with Neoral C2 monitoring adjusted to a target range of 500–600 ng/ml in long-term renal transplant recipients receiving dual immunosuppressive therapy

Abstract

There is little knowledge about the optimal 2-h post-dose concentration (C(2) level) of cyclosporin A (CsA) in renal transplant recipients beyond 1 year post-transplant. The aim of this study was to investigate the effects of C(2)-CsA monitoring on Neoral dose, renal graft function and systemic blood pressure in long-term renal transplant recipients, who had previously been monitored by means of trough levels (C(0)). Eighty-six patients treated with CsA+prednisolone were reviewed retrospectively during a follow-up period after switching to C(2)-CsA monitoring. The patients were 6.0 years (3.4, 9.0 years) [median (25% quartile, 75% quartile)] post-transplant at the time of conversion to C(2)-CsA monitoring. They were studied for 3.7 years (3.3, 3.8 years). Baseline C(0)-CsA level was 161 ng/ml (131, 208 ng/ml). The Neoral dose was reduced in 95% of the recipients. The median C(2) level was reduced by 40% to 585 ng/ml (484, 670 ng/ml) and, accordingly, the Neoral dose was reduced by 30% to 2.8 mg/kg/day (2.3, 3.8 mg/kg/day). Overall, plasma creatinine remained stable during the follow-up period. In 48/86 patients (56%), the plasma creatinine level was lower at the end of the study compared to baseline, declining from 163 micromol/l (124, 189 micromol/l) in 2001 to 147 micromol/l (106, 172) in 2005. Three patients (3.5%) had late acute rejections, 14 (16.3%) discontinued CsA, five (5.8%) commenced dialysis and seven (8.1%) died. Adoption of C(2)-CsA monitoring resulted in a substantial reduction in Neoral dose, while the overall renal graft function remained stable.