Department of Cardiology, Section of Heart and Lung Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
J Heart Lung Transplant. 2009 Sep;28(9):919-26. doi: 10.1016/j.healun.2009.05.022.
Cyclosporine (CsA) absorption varies early after transplantation and can be accurately assessed by the area under the absorption curve (AUC). The 2-hour post-dose (C2) level of CsA in whole blood is reported to be a useful surrogate marker of CsA AUC in kidney and liver transplant monitoring, but should be further explored in thoracic organ recipients.
In a 12-month study we included de novo lung (n = 95) and heart (n = 96) recipients. All participants received cyclosporine (Sandimmun Neoral) monitored by C0 and blood was collected for analysis of C2 retrospectively. Abbreviated AUC (AUC(0-4)) was measured at 7 days and 3 months. Primary outcome was C2 relation to the frequency of acute cellular rejection (ACR) needing treatment and possible decline in measured glomerular filtration rate (mGFR). Recipients were divided into lower, middle and upper third C2 groups based on 2-week post-operative values (tertiles T1 to T3).
C2 was the most robust substitute for AUC(0-4) in the group of patients studied. For lung, but not heart, recipients there were differences in mean number of ACRs (p = 0.05), incidence of any rejections (p = 0.04), mean number of any rejections (p = 0.001) and time to first rejection (p = 0.03) between T1 and T3. C2 did not predict reduction in mGFR.
C2 is a sensitive predictor for ACR in lung, but not heart, recipients, C2 was not predictive of a decline in mGFR. This study suggests that management of lung recipients by C2 may diminish the number of ACRs.
环孢素（CsA）在移植后早期的吸收情况各不相同，可以通过吸收曲线下面积（AUC）进行准确评估。全血中环孢素的 2 小时后（C2）水平被报道可作为肾和肝移植监测中 CsA AUC 的有用替代标志物，但在胸器官受者中应进一步探讨。
在一项为期 12 个月的研究中，我们纳入了 95 例肺（n=95）和 96 例心脏（n=96）移植受者。所有患者均接受环孢素（Sandimmun Neoral）治疗，并通过 C0 监测，回顾性采集血样分析 C2。在 7 天和 3 个月时测量简化 AUC（AUC(0-4)）。主要结局是 C2 与急性细胞排斥（ACR）的发生频率（需要治疗）以及测量肾小球滤过率（mGFR）的可能下降的关系。根据术后 2 周的 C2 值（三分位 T1 到 T3），将受者分为 C2 值较低、中等和较高的三组。
在研究的患者群体中，C2 是 AUC(0-4)最可靠的替代物。对于肺，而不是心脏，受者，T1 和 T3 之间在 ACR 的平均次数（p=0.05）、任何排斥反应的发生率（p=0.04）、任何排斥反应的平均次数（p=0.001）和首次排斥反应的时间（p=0.03）上存在差异。C2 不能预测 mGFR 的下降。
C2 是肺但不是心脏受者 ACR 的敏感预测因子，C2 不能预测 mGFR 的下降。这项研究表明，通过 C2 管理肺受者可能会减少 ACR 的发生。
