Journal Article

Cyclosporin exposure correlates with 1 year graft function and histological damage in renal transplanted patients

Salvatore di Paolo, Annalisa Teutonico, Giovanni Stallone, Barbara Infante, Antonio Schena, Giuseppe Grandaliano, Michele Battaglia, Pasquale Ditonno and Paolo F. Schena

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 19, issue 8, pages 2107-2112
Published in print August 2004 | ISSN: 0931-0509
Published online June 2004 | e-ISSN: 1460-2385 | DOI:
Cyclosporin exposure correlates with 1 year graft function and histological damage in renal transplanted patients

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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

Journal Article.  4057 words.  Illustrated.

Subjects: Nephrology

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