Neoral monitoring by simplified sparse sampling area under the concentration-time curve: its relationship to acute rejection and cyclosporine nephrotoxicity early after kidney transplantation.

摘要: Background Cyclosporine (CsA) dosing is traditionally based on trough blood levels (C0) rather than area under the concentration-time curve (AUC), although AUC correlates better with posttransplantation clinical events. For Neoral, limited sampling closely full 12-hr AUC. The purpose of our study was to correlate C0 CsA at 0, 1, 2, 3, and 4 hr after dose (PK0-4) compare this in predicting acute rejection (AR) cyclosporine nephrotoxicity (CsANT) de novo first kidney transplant patients. Methods PK0-4 done 2-4 days starting Neoral for 156 All received CsA-based triple-drug immunosuppression without antibody induction. calculated as projected (AUC0-12) actual 4-hr (AUC0-4) from using parallel trapezoid rule. not retrospectively compared a predictor AR CsANT during 90 days. Results correlated poorly AUC0-12 AUC0-4 (r=0.61 r=0.42). (mean+/-SEM) were significantly different 34 patients 109 (293+/-21 vs. 294+/-11 microg/L, P=0.95). lower (AUC0-12 9090+/-598 10608+/-336 microg x h/L, P=0.01; 3934+/-306 4802+/-166 microg.h/L, P=0.006). In stepwise regression analysis only or (P=0.03/P=0.02) delayed graft function (P=0.007) predicted AR. AUC0-12, AUC0-4, all higher 11746+/-650 10023+/-301 5270+/-358 4474+/-150 343+/-18 287+/-10 P=0.01), but an independent CsANT. Patients range 9500 11500 h/L between 4400 5500 had lowest incidence (13% 7%, respectively) risk Conclusion PK0-4. Early more associated C0. Our data suggest that target 9500-11500 4400-5500 may provide optimal immunosuppression.