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Impact of cyclosporine 2‐h level and mycophenolate mofetil dose on clinical outcomes in de novo heart transplant patients receiving anti‐thymocyte globulin induction
Author(s) -
Cantarovich Marcelo,
Giannetti Nadia,
Cecere Renzo
Publication year - 2003
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2003.00036.x
Subject(s) - medicine , anti thymocyte globulin , mycophenolate , gastroenterology , creatinine , mycophenolic acid , incidence (geometry) , immunosuppression , globulin , group b , renal function , heart transplantation , group a , urology , transplantation , surgery , physics , optics
Background: Cyclosporine (CsA) 2‐h post‐dose level (C 2 ) correlates better than trough levels (C 0 ) with the area under the curve. We evaluated the clinical impact of C 2 and mycophenolate mofetil (MMF) dose in adult heart transplant patients receiving anti‐thymocyte globulin (ATG) induction. Methods: Two immunosuppressive strategies were sequentially evaluated. In Group 1 (13 patients), simultaneous C 0 /C 2 (ng/mL) were analyzed. CsA dose monitoring was initially based on C 0 : <3 months: 200–300, 4–6 months: 150–250, 6–9 months: 100–200, and on C 2 thereafter (as in Group 2). In Group 2 (nine patients), C 2 monitoring was implemented: <3 months: 600–800, 4–6 months: 500–700, >6 months: 400–600. All patients received ATG induction, corticosteroids, and MMF (1.0 g b.i.d. in Group 1 and 1.5 g b.i.d. in Group 2). Results: Patients in Group 2 received higher MMF doses during the first trimester. C 2 at 1, 3, 6, 12, 24, and 36 months was, respectively, 1199 ± 476, 1202 ± 587, 999 ± 467, 664 ± 203, 593 ± 208, and 561 ± 147 in Group 1, and 809 ± 160 (p = 0.02), 644 ± 178 (p = 0.003), 664 ± 169 (p = 0.02), 616 ± 221, 464 ± 234, and 451 ± 165 in Group 2. The incidence of acute rejection (grade ≥3A) at 6, 12, 24, and 36 months was, respectively, 38.5, 38.5, 46, and 54% in Group 1, and 11, 44, 56, and 56% in Group 2 (p = NS). At 3 months, the creatinine clearance was 25% lower in Group 1. Thereafter, renal function remained stable in both groups. Conclusion: Our results suggest that heart transplant patients receiving ATG induction may experience similar outcomes with either a higher C 2 and a lower MMF dose or a lower C 2 and a higher MMF dose. These results could be considered to design prospective studies to optimize C 2 monitoring, to reduce the incidence of acute rejection without increasing the risk of renal dysfunction.