Benefit of Neoral C2 monitoring in de novo cardiac transplant recipients receiving basiliximab induction

Transplantation
Marcelo CantarovichMotown Study Group

Abstract

For cyclosporine (CsA), 2-hr postdose level (C2) is the best single time point predictor of the area under the curve and a critical measure for effective dosing. The therapeutic CsA microemulsion (Neoral) C2 range in de novo heart transplant patients remains to be determined. The purpose of this study was to determine the efficacy of CsA C2 monitoring in de novo heart transplant patients receiving basiliximab induction. This prospective, multicenter, randomized study enrolled 87 adult heart transplant recipients stratified according to 4 to 6 hrs posttransplant serum creatinine less than or equal to 170 micromol/L (cohort A) or more than 170 micromol/L (cohort B). Patients in cohort A were randomized into three C2 ranges (A1: "high" n=25, 1600-1800 ng/mL; A2: "intermediate" n=27, 1400-1600 ng/mL; and A3: "low" n=24, 1200-1400 ng/mL). Patients in cohort B were randomized into intermediate (n=5) and low C2 (n=6). Target ranges were progressively lowered after 1 month. Immunosuppression included basiliximab, Neoral, mycophenolate mofetil, and corticosteroids. Endpoints were acute rejection and renal function. The incidence of acute rejection at 12 months was 44% in group A1, 41% in group A2, 33% in group A3, and 27% in cohort B. P...Continue Reading

References

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Citations

May 22, 2009·European Journal of Clinical Pharmacology·Finn GustafssonHeather J Ross
Aug 21, 2009·Clinical Pharmacokinetics·Caroline Monchaud, Pierre Marquet
Aug 27, 2009·Clinical Pharmacokinetics·Caroline Monchaud, Pierre Marquet
Jun 23, 2009·Current Opinion in Organ Transplantation·Finn Gustafsson, Heather J Ross
Jul 21, 2010·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Maria Rosa CostanzoUNKNOWN International Society of Heart and Lung Transplantation Guidelines
May 1, 2010·Transplantation Proceedings·S-S WangC-T Shun
Oct 22, 2008·Transplant Immunology·Jignesh Patel, Jon A Kobashigawa
Jan 6, 2009·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M CantarovichM E Edwardes
Oct 29, 2008·Transplant International : Official Journal of the European Society for Organ Transplantation·Andreas Oliver Zuckermann, Arezu Z Aliabadi
Dec 17, 2011·Biotechnology and Applied Biochemistry·Nihmat MorjanaRobert Christenson
Nov 5, 2014·Transplant International : Official Journal of the European Society for Organ Transplantation·Andreas ZuckermannMarkus J Barten

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