A. Ordóñez

Comparison of monitoring trough and peak cyclosporine levels in heart transplantation

CLOSPORINE (CsA) has significantly improved the outcome of solid organ transplants. Side effects are frequently reported despite substantial efforts in therapeutic dose monitoring. The microemulsion formulation of CsA (Neoral, NEO) is less dependent on bile salts for absorption, has a lower intraand inter-individual variability, and the area under the concentration curve versus time curve (AUC) and the maximal measured concentration are higher compared to the previous formulation. Pharmacokinetic studies analyzing the relationship between trough CsA levels (whole blood concentration before the morning dose, C0) and CsA levels after 2 hours (whole blood concentration 2 hours after the morning dose, C2) with the AUC in liver, heart, and kidney transplant recipients showed a better correlation with the AUC for C2 than C0. Recent reports in heart and liver transplantation concluded that Neoral dose monitoring performed according to C2 resulted in greater clinical benefit (no rejection and no increase in serum creatinine over baseline) compared to C0. We compared dose monitoring with C2 and C0 levels in stable heart transplant recipients.