Correlation between Neoral 2 hours post-dose levels and histologic findings on surveillance biopsies

Use of 2-hour postdose (C2) monitoring has been a major step in optimizing immunosuppression following kidney transplantation, and extensive data has confirmed the superiority of C2 monitoring over the conventional trough monitoring (C0) in reducing the occurrence of acute rejection early after transplantation. In this retrospective study, we explored the relationship between Neoral pharmacokinetic parameters and the presence of subclinical rejections (ScRj). In the absence of acute rejection, lower C2 level was associated with more frequent episodes of ScRj. C0 monitoring was not predictive of AR, ScRj or any combinations thereof. Fast elimination in a subgroup of patients is not detected by the C0 and may lead to unnecessary increase of the drug dosage and increased risk of rejection.