The relative importance of cyclosporine exposure in heart, kidney or liver transplant recipients on maintenance therapy

We investigated the relationship between cyclosporine exposure and the presence of cyclosporine-related side effects and assessed the advantage of the cyclosporine concentration 2 h post-dose (C2) over pre-dose concentration (C0) monitoring. Cyclosporine area-under-the- concentration-time curves were measured during the absorption phase (AUC 0-4 h) in 49 liver, 28 heart and 26 kidney transplant recipients (time since transplantation > 6 years) with or without cyclosporine-related side effects on maintenance therapy. The cyclosporine C0 correlated well with AUC0-4 (r = 0.77), whereas C2 levels correlated strongly with AUC0-4 (r = 0.92). Although we observed a trend towards higher CsA concentrations in transplant recipients with side effects than in patients without CsA toxicity, the large majority of those differences were not statistically significant. Thus, as cyclosporine exposure was not clearly related to the presence of side effects, and C0 correlated fairly with AUC0-4, the advantage of monitoring cyclosporine treatment using C2 rather than C0, may be limited for patients on cyclosporine maintenance therapy.

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