Analysis of liver function in renal transplant recipients undergoing C2‐monitoring for cyclosporine

Summary There exists no systematic evaluation of liver function in renal allograft recipients undergoing C2‐monitoring with Neoral ® [cyclosporine A (CsA)‐microemulsion]. In the present cohort analysis, we compared the hepatic profiles of C2‐monitored ( n  = 80), C0‐monitored ( n  = 81), and non‐CsA‐treated renal allograft recipients ( n  = 29), transplanted between 1/1999 and 2/2004 in our institution. While the C2‐targets were set in accordance with ( n  = 72) or below ( n  = 8) the consensus on Neoral ® (1500 ± 200 ng/ml), non‐CsA‐patients received FK506 ( n  = 29), partially in combination with rapamycin ( n  = 13) as primary immunosuppression. Analysis of maximum hepatic laboratory parameters and also repeated measures by anova within 30 days post‐transplant revealed highly significant elevations of direct, indirect and total bilirubin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and lactate dehydrogenase ( P  < 0.001) in the C2‐group, in comparison with the C0‐ and the non‐CsA‐group. Bilirubin‐levels were by far the most affected of all hepatic parameters, and correlated with C2‐levels ( r 2  = 0.62). Seventeen CsA‐patients had excessive bilirubin‐elevations (>4 mg/dl) and were therefore considered to be ‘CsA‐sensitive’ [14 C2‐patients (17% of all C2‐patients), 3 C0‐patients (4% of all C0‐patients)]. Bilirubin‐ and the other parameter elevations in these patients were reversible upon withdrawal or lowering of CsA. Most ‘CsA‐sensitive’ patients ( n  = 12, 70%) displayed pre‐transplant hepatic impairment, indicating a pre‐existing liver instability. Collectively, our data emphasize the need for increased awareness toward individual predispositions for CsA‐sensitivity.