Furlan V, Lykavieris P, Maubert M A, Habes D, Debray D
Service de Pharmacie Clinique, Hôpital Bicêtre, APHP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
Transplant Proc. 2009 Oct;41(8):3333-4. doi: 10.1016/j.transproceed.2009.08.040.
Therapeutic drug monitoring is critical to avoid overimmunosuppression or underimmunosuppression in young pediatric transplant recipients. The objective of this study was to examine cyclosporine (CsA) trough (C0) and 2-hour post-dose (C2) concentrations in the early period after liver transplantation (OLT) to determine whether CsA C2 monitoring is justified. Seventeen infants younger than 2 years treated with CsA (Neoral) were monitored at C0. The biopsy-proved acute rejection rate was 65% at 3 months post-OLT. No correlation was observed between values at C0 and C2. Poor absorption of CsA was observed in most infants during the first 2 weeks post-OLT, as well as interindividual variability in CsA clearance. Exposure to CsA could not be estimated using either C0 or C2 determinations in the early post-OLT period. As a marker of poor absorption, C2 is useful but does not indicate delayed or rapid clearance of drug without simultaneous measurement of concentration at C0. We suggest the use of both C0 and C2 monitoring, or AUC monitoring on an individual basis during at least the first 2 weeks post-OLT.
治疗药物监测对于避免小儿移植受者出现免疫抑制过度或不足至关重要。本研究的目的是检测肝移植（OLT）术后早期环孢素（CsA）的谷浓度（C0）和服药后2小时浓度（C2），以确定监测CsA的C2是否合理。对17例接受CsA（新山地明）治疗的2岁以下婴儿进行了C0监测。OLT术后3个月经活检证实的急性排斥反应发生率为65%。未观察到C0和C2值之间存在相关性。在OLT术后的前2周，大多数婴儿出现CsA吸收不良，以及CsA清除的个体差异。在OLT术后早期，无法通过C0或C2测定来估计CsA的暴露量。作为吸收不良的标志物，C2是有用的，但如果不同时测量C0浓度，则无法表明药物清除延迟或迅速。我们建议在OLT术后至少前2周内，对个体同时使用C0和C2监测，或进行AUC监测。
