Serón D, Moreso F
Nephrology Department, Hospital Universitario de Bellvitge, Barcelona, Spain.
Transplant Proc. 2004 Mar;36(2 Suppl):257S-260S. doi: 10.1016/j.transproceed.2004.01.035.
During the last 20 years the management of cyclosporine (CsA) has improved due to the introduction of microemulsion technology, C2 monitoring, and combination with other new immunosuppressants. All these modifications have reduced the incidence of biopsy-proven acute rejection episodes to approximately 10%. However despite the wide experience, there are unanswered questions regarding CsA monitoring after the first year. Available clinical and histological data suggest that the therapeutic range to avoid nephrotoxicity or underimmunosuppression during the maintenance period is rather narrow. Furthermore, the combination of CsA with new immunosuppressants may modify the target CsA levels. Although the utility of C2 levels during the first year has been well characterized, there are few data on its utility for maintenance therapy, particularly the therapeutic range for C2 levels in patients receiving different immunosuppressive combinations. Since serum creatinine does not precisely reflect the progression of chronic allograft nephropathy, the efficacy of C2 monitoring during the maintenance period must be assessed not only by means of evaluation of renal function, but also histologic assessment using protocol biopsies.
在过去20年里，由于微乳剂技术的引入、C2监测以及与其他新型免疫抑制剂联合使用，环孢素（CsA）的管理得到了改善。所有这些改进已将经活检证实的急性排斥反应发生率降低至约10%。然而，尽管有丰富的经验，但关于CsA在第一年之后的监测仍存在未解决的问题。现有的临床和组织学数据表明，在维持期避免肾毒性或免疫抑制不足的治疗范围相当狭窄。此外，CsA与新型免疫抑制剂联合使用可能会改变目标CsA水平。尽管C2水平在第一年的效用已得到充分表征，但关于其在维持治疗中的效用的数据很少，尤其是接受不同免疫抑制联合治疗的患者中C2水平的治疗范围。由于血清肌酐不能准确反映慢性移植肾肾病的进展，维持期C2监测的疗效不仅必须通过评估肾功能来评估，还必须通过使用方案活检进行组织学评估。
