| C2 therapeutic drug monitoring of cyclosporine is a safe and feasible method in de novo heart transplant patients. | |
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MedLine Citation:
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PMID: 18089381 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The narrow therapeutic window of cyclosporine (CsA) requires close therapeutic drug monitoring (TDM). While C2-TDM has been established after renal and liver transplantations, clinical experience is limited for patients after de novo heart transplantation (HTX). PATIENTS AND METHODS: In a retrospective study, we investigated 40 patients undergoing HTX; 34 patients received induction therapy using antithymocyte globulin (ATG Mérieux). Immunosuppression was administered with CsA (Sandimmun-Optoral), with dosages adjusted according to C2 levels (800-1100 ng/mL during the first 6 months and reduced to 400-600 ng/mL from the beginning of the first year). At different times TI (months 1-3). TII (months 12-14) TIII (months 24-26), and TIV (months 34-36), we obtained measures of acute cellular rejections (ARs), cytomegalovirus (CMV) infections, creatinine, and safety laboratory parameters. RESULTS: The cumulative survival was 95% after 1 year, and 88% after 3.8 years. Eight ARs were diagnosed at a mean of 7.6 months after HTX in 7 patients. Twenty-four CMV infections/reactivations were verified. In 10 cases, treatment was started because of clinical symptoms. The mean creatinine values significantly rose in the early postoperative phase (TI: 1.23+/-0.47 mg/dL, TII: 1.49+/-0.41 mg/dL; P<.0001). Thereafter the creatinine values declined; however, this was not statistically significant (TIII: 1.38+/-0.57 mg/dL, TIV: 1.15+/-0.30 mg/dL). All other safety parameters showed no significant changes. CONCLUSIONS: C2 allows individualization of immunosuppression with reduced CsA toxicity, but without loss in safety among de novo patients after HTX. We obtained freedom from severe AR, a low number of CMV infections, and excellent patient survival. |
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Authors:
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T Puehler; L Goepel; M v Tschirschnitz; U Struckmeyer; M Ernst; S Ladenburger; C Schmid; J Cremer; S W Hirt |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Transplantation proceedings Volume: 39 ISSN: 0041-1345 ISO Abbreviation: Transplant. Proc. Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-12-19 Completed Date: 2008-02-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
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Languages: eng Pagination: 3329-33 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany. tpuehler@kielheart.uni-kiel.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Alanine Transaminase
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blood Aspartate Aminotransferases / blood Cholesterol / blood Creatine Kinase / blood Creatinine / blood Cyclosporine / pharmacokinetics*, therapeutic use Drug Monitoring / methods, standards Heart Transplantation / immunology*, mortality Humans Immunosuppressive Agents / pharmacokinetics, therapeutic use Lipoproteins / blood Retrospective Studies Safety Survival Analysis Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents; 0/Lipoproteins; 57-88-5/Cholesterol; 59865-13-3/Cyclosporine; 60-27-5/Creatinine; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase; EC 2.7.3.2/Creatine Kinase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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