Takatsuki Mitsuhisa, Chen Chao-Long, Chen Yaw-Sen, Wang Chih-Chi, Lin Chih-Che, Yang Chin-Hsiang, Yong Chee-Chien, Liu Yueh-Wei
Liver Transplant Program, Department of Surgery, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.
Clin Transplant. 2004 Dec;18(6):694-9. doi: 10.1111/j.1399-0012.2004.00279.x.
The efficacy and feasibility of 2-h post-dose level (C2) monitoring of cyclosporine in long-term living donor liver transplantation (LDLT) is not clear. The aim of this study was to investigate the impact of late conversion from conventional trough-level (C0) monitoring to C2 monitoring of a microemulsion form of cyclosporine (Neoral) in pediatric LDLT recipients. From June 1994 to August 2002, we performed 116 LDLTs in 115 patients. Initially, we adapted conventional C0 monitoring of Neoral, which was converted to C2 monitoring starting in January 2002. The 60 patients who were enrolled in the study had the following characteristics: they were younger than or equal to 15 yr at transplantation, and they had survived LDLT, and they had received a Neoral-based immunosuppression regimen, and they underwent conversion to C2 more than 1 month after transplantation. We evaluated the impact of conversion on doses, blood levels, rejection, adverse effects, and patient/graft outcome. In the long-term patients, the mean C2 levels immediately after conversion were higher than the target levels at any time point selected after transplantation; thus, 34 patients (57%) finally required a dose reduction of Neoral. The current mean C2 level was significantly lower than that observed immediately after conversion (584.6 +/- 262.8 ng/ml vs. 893.1 +/- 260.2 ng/ml, mean +/- SD, p < 0.0001) with a mean follow-up period of 7.4 +/- 0.6 months (range: 5-8 months) after conversion. Only one patient encountered rejection after conversion (1.7%), and no de novo infection or adverse effects were observed. Traditional C0 monitoring of Neoral was safely replaced by C2 monitoring without an increase in the rejection rate or any adverse effects in pediatric LDLT patients. C2 monitoring contributed to the dose reduction of Neoral, which may lead to the avoidance of long-term complications due to immunosuppression.
在长期活体供肝肝移植（LDLT）中，环孢素给药后2小时血药浓度水平（C2）监测的有效性和可行性尚不清楚。本研究的目的是调查在小儿LDLT受者中，将环孢素微乳剂（新山地明）从传统的谷浓度（C0）监测改为C2监测的后期影响。1994年6月至2002年8月，我们对115例患者实施了116例LDLT。最初，我们采用新山地明的传统C0监测，从2002年1月开始改为C2监测。纳入研究的60例患者具有以下特征：移植时年龄小于或等于15岁，LDLT存活，接受基于新山地明的免疫抑制方案，且移植后1个月以上改为C2监测。我们评估了转换对剂量、血药浓度、排斥反应、不良反应以及患者/移植物结局的影响。在长期患者中，转换后即刻的平均C2水平高于移植后所选任何时间点的目标水平；因此，34例患者（57%）最终需要减少新山地明的剂量。转换后平均随访7.4±0.6个月（范围：5 - 8个月），当前平均C2水平显著低于转换后即刻观察到的水平（584.6±262.8 ng/ml对893.1±260.2 ng/ml，均值±标准差，p < 0.0001）。转换后仅1例患者发生排斥反应（1.7%），未观察到新发感染或不良反应。在小儿LDLT患者中，新山地明的传统C0监测可安全地被C2监测取代，且排斥反应率或任何不良反应均未增加。C2监测有助于减少新山地明的剂量，这可能有助于避免免疫抑制引起的长期并发症。
