An approach to optimization of monitoring of CyA therapy in long term kidney transplant recipients
Abstract
The Cyclosporine-based therapy is the most used immunosupression in kidney transplantation. The efficacy of cyclosporine therapy has been improved by monitoring drug concentration. But routine trough level which is still widely used to guide dose adjustment correlates poorly with the total drug exposure and with clinical events in patients after kidney transplantation. The aim of the study was to compare two different schemes of CyA-monitoring (С0, С2 and C0 + C1 + C3), to correlate cyclosporine pharmacokinetics and both kidney graft function and pathology in long-term kidney transplant recipients. 123 CsA pharmacokinetic studies were performed in 83 recipients. The patients were divided into 4 groups: 1 - stable graft function (n = 28); 2 - chronic allograft nephropathy or glomerulonephritis (n = 25); 3 - late acute rejection (n = 12); 4 - chronic CsA nephrotoxicity (n = 18). The patients of all groups had approximately the same C0 level, but CsA exposure estimated from AUC and C2 single-point sample proved to be significantly different in the groups with late acute rejection and chronic CsA nephrotoxicity compared to patients with stable graft function. AUC measurement using a limited sample strategy (LSS) (0, 1 and 3 hours postdose) has been shown to be an accurate method of estimating AUC. From the single time point measurement the best correlation with AUC was found for C3 (r2 = 0,68) and C2 (r2 = 0,65).
About the Authors
E. S. Stoliarevich
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
A. V. Sukhanov
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
A. R. Bagdasaryan
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
F. S. Baranova
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
L. K. Popova
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
N. D. Fiodorova
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
N. A. Tomilina
НИИ трансплантологии и искусственных органов Минздрава РФ, Москва
Russian Federation
Russian Federation
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Review
For citations:
Stoliarevich E.S., Sukhanov A.V., Bagdasaryan A.R., Baranova F.S., Popova L.K., Fiodorova N.D., Tomilina N.A. An approach to optimization of monitoring of CyA therapy in long term kidney transplant recipients. Nephrology and Dialysis. 2004;6(2):145-154. (In Russ.)
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