Optimal sampling time‑point for cyclosporin A concentration monitoring in heart transplant recipients

Jia,Yixin; Meng,Xu; Li,Yan; Xu,Chunlei; Zeng,Wen; Jiao,Yuqing; Han,Wei

doi:10.3892/etm.2018.6711

Optimal sampling time‑point for cyclosporin A concentration monitoring in heart transplant recipients

Authors:
- Yixin Jia
- Xu Meng
- Yan Li
- Chunlei Xu
- Wen Zeng
- Yuqing Jiao
- Wei Han
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Affiliations: Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, P.R. China
Published online on: September 10, 2018 https://doi.org/10.3892/etm.2018.6711
Pages: 4265-4270

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Abstract

The present study was performed to determine an optimal time‑point for monitoring the concentration of the immunosuppressive drug cyclosporin A (CsA) in heart transplant patients and its efficacy in the prevention of transplant rejection. A total of 32 transplant recipients were randomly assigned for three treatment approaches. Recipients in groups A (n=11), B (n=13) and C (n=8) received oral administration of CsA at doses of 3.2, 3.5 and 4.4 mg/kg, respectively. The plasma CsA concentrations were examined at 2 h intervals over 12 h. Furthermore, their correlation with the 4 h pharmacokinetic profiles as the area under the plasma CsA concentration vs. time curve (AUC0‑4 h) were calculated The efficacy of CsA in inhibiting cardiac allograft rejection was assessed at 2 h after oral CsA intake (C2) and adverse events of the drug were examined in the C2‑monitored recipients. The plasma CsA concentration rapidly increased in most recipients with a peak level detected at ~2 h after dosing. Regression analysis revealed that among all time‑points assessed, the CsA had the highest correlation with the AUC0‑4 h at C2. At C2, increasing CsA doses exhibited a positive association with the measure of AUC0‑4 h. The efficacy of increasing CsA target levels at C2 in preventing heart transplant rejection was comparable, as the survival rate was 100% in all of the treatment groups. However, the proportion of recipients with side effects in group A was obviously lower than that in the other two groups. In conclusion, C2 is an ideal time‑point for monitoring plasma CsA levels with a utility for individualising the next scheduled dose for each patient to ensure that target levels are maintained and achieve a high efficacy and safety of CsA therapy in heart transplant recipients (clinical trial no. 12002610).

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