Zhang Y, Zhang X D, Wang Y
Urology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Transplant Proc. 2011 Dec;43(10):3697-701. doi: 10.1016/j.transproceed.2011.08.105.
Cyclosporine doses can be adjusted individually to decrease the occurrence of rejection and nephrotoxic episodes using concentrations at 2 hours postdosing (C2). However, some transplantation centers still use trough concentrations (C0) to adjust cyclosporine doses among stable renal transplant recipients. We analyzed the efficacy and safety of changing from monitoring C0 to C2 among stable recipients following living relative donor renal transplantation. We enrolled 65 stable renal transplant recipients whose cyclosporine (Neoral) dosages were adjusted by C0, recording their cyclosporine C2 values. They were divided into low (<500 ng/mL, n=25), target (500-600 ng/mL, n=23), or high (>600 ng/mL, n=17) C2 groups. The cyclosporine dose was prospectively modified in the low and high C2 groups; all patients were followed for 12 months. We compared the incidences of complications among their transplanted kidneys and other organs. Among patients in the high C2 group, the C2 target value was achieved by reducing the cyclosporine dose by up to 575.0 mg (mean=33.8 mg/patient); 88.2% of patients showed stable levels of creatinine (Cr) and urea nitrogen (BUN) during the follow-up with decreased blood cholesterol and uric acid levels in some patients, while two subjects suffered acute rejection episodes. Among the low C2 group, the target value was achieved by increasing the cyclosporine dose by up to 755.0 mg (mean=30.2 mg/patient); during the follow-up with 84.0% of subjects displaying stable levels of Cr and BUN, four suffered increasing Cr and BUN values. Although most of stable recipients in this study benefited from C2 monitoring, some patients suffered rejection or nephrotoxicity episodes. One must be cautious to change from monitoring C0 to C2 in stable recipients following renal transplantation.
环孢素剂量可根据给药后2小时的血药浓度（C2）进行个体化调整，以减少排斥反应和肾毒性事件的发生。然而，一些移植中心仍在稳定的肾移植受者中使用谷浓度（C0）来调整环孢素剂量。我们分析了在亲属活体供肾移植后的稳定受者中，从监测C0改为监测C2的疗效和安全性。我们纳入了65例稳定的肾移植受者，其环孢素（新山地明）剂量通过C0进行调整，并记录他们的环孢素C2值。他们被分为低C2组（<500 ng/mL，n = 25）、目标C2组（500 - 600 ng/mL，n = 23）或高C2组（>600 ng/mL，n = 17）。低C2组和高C2组的环孢素剂量进行了前瞻性调整；所有患者随访12个月。我们比较了他们移植肾和其他器官并发症的发生率。在高C2组患者中，通过将环孢素剂量最多减少575.0 mg（平均 = 33.8 mg/患者）达到了C2目标值；88.2%的患者在随访期间肌酐（Cr）和尿素氮（BUN）水平稳定，部分患者血胆固醇和尿酸水平降低，而两名受试者发生了急性排斥反应。在低C2组中，通过将环孢素剂量最多增加755.0 mg（平均 = 30.2 mg/患者）达到了目标值；在随访期间，84.0%的受试者Cr和BUN水平稳定，四名患者的Cr和BUN值升高。虽然本研究中的大多数稳定受者从C2监测中获益，但一些患者发生了排斥反应或肾毒性事件。在肾移植后的稳定受者中，从监测C0改为监测C2时必须谨慎。
