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Satisfactory outcome despite low 2-hour postdose cyclosporine level in Iranian kidney recipients

Vahid Pourfarziani1, Eqlim Nemati, Saeed Taheri

  • 1Kidney Transplant Department, Baqiyatallah University of Medical Sciences, Tehran, Iran. cru.common@yahoo.com

Iranian Journal of Kidney Diseases
|April 21, 2009
PubMed
Abstract

Insights

In Iranian kidney transplant patients, lower-than-recommended cyclosporine serum levels (C2) were common but associated with good long-term patient and graft survival, suggesting population-specific targets may be needed.

Area of Science:

  • Nephrology
  • Immunosuppression Therapy
  • Transplantation Medicine

Background:

  • Cyclosporine (CsA) exhibits a narrow therapeutic index in kidney transplantation, necessitating precise serum level monitoring.
  • The impact of CsA levels on long-term outcomes across diverse ethnic groups remains incompletely understood.
  • This study focuses on the 2-hour postdose serum concentration (C2) of CsA in Iranian kidney transplant recipients.

Purpose of the Study:

  • To investigate the relationship between CsA C2 levels and long-term patient and graft survival in Iranian kidney transplant recipients.
  • To assess adherence to recommended CsA C2 target ranges within this specific population.
  • To explore potential ethnic variations in optimal CsA therapeutic targets.

Main Methods:

  • A cohort of 397 kidney transplant recipients treated with prednisolone, mycophenolate mofetil, and CsA (Neoral) was analyzed.
  • CsA C2 levels were measured at multiple intervals: 0-2 months, 2-6 months, and >6 months post-transplant.
  • Mean C2 levels were compared to established optimal ranges, and patient/graft survival rates were calculated.

Main Results:

  • A high prevalence of C2 levels below the upper recommended range was observed: 96.9% (0-2 months), 83.6% (2-6 months), and 64.5% (>6 months).
  • Despite lower C2 levels, the overall 5-year patient survival rate was 95%.
  • The overall 5-year graft survival rate was 85%.

Conclusions:

  • Good patient and graft survival rates were achieved in Iranian kidney transplant recipients despite a majority having C2 levels below recommended values.
  • These findings suggest that current therapeutic target ranges for CsA C2 may not be universally applicable.
  • Further research is warranted to define population-specific optimal CsA C2 targets for kidney transplant recipients.

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