Cyclosporine C2 Levels Have Impact on Incidence of Rejection in De Novo Lung but Not Heart Transplant Recipients: The NOCTURNE Study

Martin Iversen, Folke Nilsson, Jorma Sipponen, Hans Eiskjaer, Lena Mared, Stein Bergan, Ulla Nystrom, Hans E. Fagertun, Dag Solbu, Svein Simonsen

Research output: Chapter in Book/Report/Conference proceedingPaper in conference proceedingResearchpeer-review

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Abstract

Background: Cyclosporine (CsA) absorption varies early after transplantation and can be accurately assessed by the area under the absorption curve (AUC). The 2-hour post-dose (C2) level of CsA in whole blood is reported to be a useful surrogate marker of CsA AUC in kidney and liver transplant monitoring, but should be further explored in thoracic organ recipients. Methods: In a 12-month study we included de novo lung (n = 95) and heart (n = 96) recipients. All participants received cyclosporine (Sandimmun Neoral) monitored by CO and blood was collected for analysis of C2 retrospectively. Abbreviated AUC (AUC(0-4)) was measured at 7 days and 3 months. Primary outcome was C2 relation to the frequency of acute cellular rejection (ACR) needing treatment and possible decline in measured glomerular filtration rate (mGFR). Recipients were divided into lower, middle and upper third C2 groups based on 2-week post-operative values (tertiles T1 to T3). Results: C2 was the most robust substitute for AUC(0-4) in the group of patients studied. For lung, but not heart, recipients there were differences in mean number of ACRs (p = 0.05), incidence of any rejections (p = 0.04), mean number of any rejections (p = 0.001) and time to first rejection (p = 0.03) between T1 and T3. C2 did not predict reduction in mGFR. Conclusions: C2 is a sensitive predictor for ACR in lung, but not heart, recipients, C2 was not predictive of a decline in mGFR. This study suggests that management of lung recipients by C2 may diminish the number of ACRs. J Heart Lung Transplant 2009; 28:919-26. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.
Original languageEnglish
Title of host publicationJournal of Heart and Lung Transplantation
PublisherElsevier
Pages919-926
Volume28
DOIs
Publication statusPublished - 2009
Event29th Annual Meeting and Scientific Session of the International-Society-for-Heart-and-Lung-Transplantation - Paris, France
Duration: 2009 Apr 222009 Apr 25

Publication series

Name
Number9
Volume28
ISSN (Print)1053-2498
ISSN (Electronic)1557-3117

Conference

Conference29th Annual Meeting and Scientific Session of the International-Society-for-Heart-and-Lung-Transplantation
Country/TerritoryFrance
CityParis
Period2009/04/222009/04/25

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

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