Background: Recent studies suggest that cyclosporine dose adjustment based on C2 levels results in improvement of renal function. This study investigates the effect on renal function after dose reduction based on the C2 levels in long-term liver transplant patients. Methods: In 60 patients (> 1 yr after transplantation), C2 levels were assessed (target 600 ng/mL ± 20%). Dose reduction was performed when C2 > 720 ng/mL. Serum creatinine concentrations were measured and creatinine clearance was calculated. Results: Twenty-three patients (38%) had C2 values > 720 ng/mL. After dose reduction, mean cyclosporine dose decreased by 25% (p < 0.01). Mean C2 value decreased by 42% (p < 0.01). Serum creatinine concentrations remained stable. After dose reduction two patients experienced recurrence of PBC, in one patient AIH recurred and rejection was diagnosed in one patient. Conclusion: Cyclosporine C2 concentrations above 720 ng/mL are common in long-term liver transplant patients. Dose reduction of 25% did not improve kidney function and was accompanied by immune activation.

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Clinical Transplantation
Department of Surgery

Tha-In, T., Hesselink, D., Tilanus, H., Elshove, L., Wilschut, A., Hansen, B., … Metselaar, H. (2005). Clinical outcome after cyclosporine dose reduction based on C2 levels in long-term liver transplant patients. Clinical Transplantation, 19(4), 537–542. doi:10.1111/j.1399-0012.2005.00385.x