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Cyclosporin A monitoring by 2‐h levels: preliminary target levels in stable pediatric kidney transplant recipients
Author(s) -
Pape L,
Lehnhardt A,
Latta K,
Ehrich JHH,
Offner G
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 - 10.1046/j.1399-0012.2003.00107.x
Subject(s) - medicine , renal function , confidence interval , urology , kidney transplantation , transplantation , kidney , trough level , gastroenterology , tacrolimus
Clinical trials in adults have shown that management of transplanted patients with cyclosporin A (CsA) 2‐h levels (C2) lead to superior outcome compared with monitoring of 12‐h trough levels (C0). In both adults and children, C2 levels enabled a better estimation of the area under the curve concentration than C0 levels. Therefore, it can be suspected that C2 monitoring might also lead to a better outcome in children. Until now C2 target levels for children have not been defined. We measured C2 levels in 101 stable pediatric kidney recipients with a minimum time of 1 yr after transplantation. C2 levels were compared with changes in glomerular filtration rate (GFR) 6 months later. Median C2 levels in children after renal transplantation were 714 ng/mL (95% confidence interval 654–774). Patients with C2 levels below 750 ng/mL had a significantly higher percentage of decline in GFR than patients with C2 levels above 750 ng/mL (p < 0.05). In children with C2 levels below 500 ng/mL three acute rejections occurred in comparison with no rejection in the remaining patients (p < 0.05). We conclude that the lower C2 target level should be above 750 ng/mL in stable pediatric transplant recipients. An upper target level above 1000 ng/mL should be avoided. The question, whether C2 monitoring in pediatric kidney recipients is superior to C0 monitoring, is yet to be answered.