Validity of C2 Monitoring of Microemulsion Cyclosporine in Early Renal Transplant Period / 대한이식학회지

PURPOSE: Four-hour area under the concentration-time curve (AUC0-4) was considered to be superior rather than C0 in predicting the development of acute rejection, and was reported most well correlated with C2 in post-transplant period. The purpose of this study was to demonstrate the correlation between AUC0-4 and each C0,1,2,3,4, and to compare C2 with C0 in predicting acute rejection in de-novo kidney recipients. METHODS: Fifty- six adult living donor kidney transplants were followed up 3 months after transplantation. Cyclosporine A (CsA) dose was adjusted with C0. AUC0-4 was measured on 5th and 19th post-operative day, and C2 as well as C0 was measured on post-operative 5, 12, 19, 30, 60, 90 days. RESULTS: Fifteen patients (26.8%) experienced acute rejection 12.0+/-10.9 (5~48) days after transplantation. CsA absorption pharmacokinetics was different with data based on Caucasian recipients. In more than 60% of patients, peak concentration (Cmax) was reached 2 hours after oral intake of CsA regardless the occurrence of acute rejection and postoperative days. AUC0-4 was most critically correlated with C2 on 5th and 19th post-operative days (R2>0.800, respectively). Recipients having acute rejection between 5th and 7th post-operative day, had statistically lowered AUC0-4, C2, C3 (P<0.05) compared with patients without acute rejection. CONCLUSION: In early post-transplant days, AUC0-4 was powerfully correlated with C2. Monitoring of C2 rather than C0 could predict the occurrence of acute rejection in this period. Value of C2 monitoring in Koreans beyond 7th day awaits further study by adjusting CsA dose with C2 rather than C0.

Influence of the True Living Donor Kidney-Weight to Recipient Body-Weight Ratio on the Post-Transplant 1 Year Renal Allograft Function

The importance of the donor-to-recipient body surface area ratio or the calculated donor kidney-weight to recipient body-weight ratio is still matter of controversy in clinical renal transplantation(Tx). To assess the value of the true kidney weight(KW in gms) to the recipient body-weight(BW in kg) ratio in living donor renal Tx, the records of 165 adult living donor renal transplants were reviewed. All patients received uniform cyclosporine and steroid immunosuppression. Five patients were excluded because of early graft loss. In the remaining 160 patients, full information including KW, BW, degree of HLA matching, demographics of recipient and donor, acute rejection(AR) episodes, serum creatinine(Scr) at post-Tx 1 month and 1 year, 24 hours urinary excretion of protein at post-Tx 1 year and finally outcome of graft were available. Patients with KW/BW3.5, but this difference was not statistically significant. These findings were still true even if we eliminated the effect of acute rejection episodes. In 96 patients that never experienced acute rejection, we could demonstrate the significant impact of KW/BW on the Scr. In conclusion, if the Scr at post-Tx 1 year is a major determinant of the long-term graft outcome, the important role of KW/BW ratio is must considered in the selection of a potential living donor.

Influence of the True Living Donor Kidney-Weight to Recipient Body-Weight Ratio on the Post-Transplant 1 Year Renal Allograft Function

The importance of the donor-to-recipient body surface area ratio or the calculated donor kidney-weight to recipient body-weight ratio is still matter of controversy in clinical renal transplantation(Tx). To assess the value of the true kidney weight(KW in gms) to the recipient body-weight(BW in kg) ratio in living donor renal Tx, the records of 165 adult living donor renal transplants were reviewed. All patients received uniform cyclosporine and steroid immunosuppression. Five patients were excluded because of early graft loss. In the remaining 160 patients, full information including KW, BW, degree of HLA matching, demographics of recipient and donor, acute rejection(AR) episodes, serum creatinine(Scr) at post-Tx 1 month and 1 year, 24 hours urinary excretion of protein at post-Tx 1 year and finally outcome of graft were available. Patients with KW/BW3.5, but this difference was not statistically significant. These findings were still true even if we eliminated the effect of acute rejection episodes. In 96 patients that never experienced acute rejection, we could demonstrate the significant impact of KW/BW on the Scr. In conclusion, if the Scr at post-Tx 1 year is a major determinant of the long-term graft outcome, the important role of KW/BW ratio is must considered in the selection of a potential living donor.

Long-term Effect of Conversion from Conventional Cyclosporine to Microemulsion Cyclosporine in Renal Allograft Recipient: 1 year follow-up study / 대한이식학회지

Recently a new formulation of CsA, based on microemulsion technology, has been developed and became available. This improved galenic technology allows more predictable and consistent absorption, thus minimizing inter-patient and intra-patient variability and permitting more predictable whole blood CsA concentration. The objectives of this study are to assess 1) long-term safety and tolerability in renal transplant patients when switched from conventional CsA(Con-CsA) to microemulsion CsA(Me-CsA), 2) the ability of Me-CsA to maintain CsA blood trough levels in the predefined therapeutic window, and 3) the long-term side effects of Me-CsA. A total number of 965 renal transplant patients had been surveyed. These patients had to have variable graft function under Con-CsA based immunosuppression and at least 1 month passed since their last graft. After a one month run-in phase, Con-CsA was converted to Me-CsA patients on a 1:1 dose level basis. The clinical status such as graft dysfunction, graft and patient survival, medical illness and side effects were monitored. The clinical laboratory studies such as CBC, BUN, creatinine, serum electrolyte, liver function test, blood cyclosporine trough level and 24hr urinary excretion of protein were monitored every 3 or 6 months for 1 year. The results of our research are as following; 1) During conversion period from Con-CsA to Me-CsA, there was no episode of Me-CsA related side effects and admission cases. 2) There were statistical differences in mean CsA blood level during Con-CsA period, but no significant distinctions were noted during Me-CsA period. 3) Daily dosages of the Con-CsA were statistically variable between one month interval periods, but the Me-CsA daily dosages were statistically stable between 3,6,9, and 12 months after the conversion. 4) Serum creatinine level did not change significantly by the conversion.