NDT Advance Access originally published online on June 8, 2004
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Nephrol Dial Transplant (2004) 19: 2107-2112
Nephrol Dial Transplant Vol. 19 No. 8 © ERA-EDTA 2004; all rights reserved
Original Article
Cyclosporin exposure correlates with 1 year graft function and histological damage in renal transplanted patients
1 Department of Emergency and Organ Transplantation, Division of Nephrology and 2 Department of Emergency and Organ Transplantation, Division of Urology, University of Bari, Bari, Italy
Correspondence and offprint requests to: Salvatore di Paolo, MD, Department of Emergency and Organ Transplant, Division of Nephrology, University of Bari, Policlinico, Piazza Giulio Cesare 11, I-70124 Bari, Italy. Email: s.dipaolo{at}nephro.uniba.it
Background. Cyclosporin (CsA) level obtained 2 h after the morning dose (C2) has been shown to accurately predict total CsA exposure and acute rejection (AR) risk, whereas conventional trough levels (C0) do not. The impact of C2 monitoring on long-term kidney graft function, independent from AR risk, is still unclear, however, and it was assessed in the present study.
Methods. We enrolled 39 CsA-treated renal transplant recipients and used 1 year graft function and histological structure as surrogate markers of graft outcome. CsA dose was adjusted according to C2 levels.
Results. In the first 7 days after grafting, 40–51% of patients failed to reach target C2 levels; nevertheless, at 1 year the incidence of AR was only 2.5% and graft and patient survival was 100%. The decrease of serum creatinine (12–6 months) was associated with significantly higher C2 levels over time (P = 0.0003) and lower intrapatient variability of CsA relative absorption (CV) (P = 0.0006). One year graft biopsy showed chronic tubulointerstitial lesions in 54.5% of patients. Both C2 mean levels and the percentage CV independently predicted the severity of chronic histological lesions (R = 0.69, P<0.0001).
Conclusions. Higher C2 levels, within the proposed target range values, seem to be associated with better renal function and structure.
Keywords: C2 monitoring; chronic allograft nephropathy; cyclosporin; graft function; kidney transplantation
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