A comparison between the levels of cyclosporine C0 and C2 in children undergoing renal transplantation

Background: Cyclosporine A (CSA) with intra- and inter-individual variability in absorptive property needs individualized dose adjustment in patients receiving the drug. This study was performed to compare cyclosporine C0 (before morning dose) and C2 (two hours after morning dose) levels in order to adjust the maintenance dose of CSA in stable renal transplant patients in Shiraz, southern Iran. Methods: From October 2004 to June 20,05, 64 kidney transplants of Nemazee Hospital entered our study. All patients underwent renal transplantation for the first time except one subject who received the second transplant. All patients received three immunosuppressive drugs of which CSA was administered in two divided doses in the form of microemulsion. The height, weight, blood pressure, periodical tests and C0 and C2 levels were determined at the time of referral, as well as one and 5 months later. The amount of CSA was adjusted based on C0 levels of 100-250 ng/mL. The patients were divided into two C0 subgroups with C0 levels of <100 and >= 100 ng/mL. In regard to C2, the two subgroups were <800 and >= 800 ng/mL. In addition to CSA, cellcept and prednisolone were administered to 47, immuran with prednisolone to 15, and only prednisolone to 2 patients. Results: Comparing the two subgroups of C0 and C2, no differences were observed between serum creatinine level, CSA doage and the drug complications. A significant correlation was found between C0 and C2 levels, and also between C2 level and CSA dosage. A negative correlation was seen between C0 level and serum creatinine. The coefficient of variation of the three samples of each patient was 10.89% for C0, and 8.94% for C2 with constant drug regimen. As there was no significant difference between mean C0 and C2 levels, and renal function at the start and the end of study, there seemed to be no need to recommend C2 level for follow up of renal transplantation.