Long-term comparative results of C0 and C2 monitoring of CyA in renal transplanted patients.

The purpose of this study was to evaluate the effects of CyA monitoring using C0 monitoring (fasting level after 12 h from last dose), and C2 monitoring (2 h after morning dose) on renal functions, lipid levels, CyA levels, and daily dosages of CyA in renal transplanted patients in the posttransplant period from the first month to the 36th month. In our center between 1992-2003, 37 of the 54 renal transplanted patients were treated with CyA, prednisolone, and mycophenolate mofetil or azathioprine. The mean age was 32.36 +/-10.32 and 35.00 +/- 10.23 (p = 0.39) in C0 (M/F: 18/7) and in C2 (9/3), respectively. Cadaveric donor (d), living related d, and living unrelated d were in four patients (p), 17 p and four p in C0, and two p, seven p, and three p in C2, respectively (p = 0.79). Chronic allograft nephropathy (CAN) developed in 13 p (52%) and one p (8.3%) in C0 and in C2, respectively (p =0.013). Creatinine clearance values were 72.31 +/- 23.10 mL/min and 78.73 +/- 22.42 mL/min (p:0.621) at first month, 64.97 +/- 22.58 mL/min and 78.00 +/- 19.90 mL/min (p:0.065) at sixth month, 56.50 +/- 19.62 mL/min and 76.62 +/- 21.06 mL/min (p:0.006) at 12th month, 50.28 +/- 24.79 mL/min and 80.87 +/- 18.24 mL/min (p < 0.001) at 24th month, and 55.15 +/- 19.21 mL/min and 86.65 +/- 14.97 mL/min (p:0.004) at 36th month in C0 and C2, respectively. The mean daily dosages of CyA were 354.35 +/- 122.63 and 266.67 +/- 64.95 mg/d (p:0.031) at first month, 277.17 +/- 77.94 and 250.00 +/- 73.31 mg/d (p:0.228) at sixth month, 247.92 +/- 58.48 and 211.36 +/- 62.61 mg/ d (p:0.09) at 12th month, 232.95 +/- 56.90 and 170.45 +/- 41.56 mg/ d (p:0.003) at 24th month, and 240.63 +/- 52.34 and 153.57 +/- 46.61 mg/d (p:0.002) at 36th month in C0 and C2, respectively. In C2, systolic and diastolic blood pressure, uric acid, total cholesterol (C), LDL-C, and triglyceride levels were lower than those monitored with C0. In C2, HDL-C levels were also higher than those monitored with C0. None of these patients returned to dialysis or died in this period. In conclusion, during the first 36 months with monitoring C2, preservation of renal function, control of blood pressure serum lipids and uric acid were better than those with monitoring C0. In addition, daily dose of CyA was lower in C2 method and, at the same time, this effect of C2 can be accepted as cost effective.