ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
CYCLOSPORINE MONITORIZATION AND ITS IMPORTANCE IN IMMUNOSUPRESSIVE TREATMENT AFTER CARDIAC TRANSPLANTATION
Mehmet Ali Özatik Şeref Küçüker, Mustafa Balcı Deniz Süha Küçükaksu
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, Ankara
*Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, İmmunoloji Laboratuarı, Ankara
Background: Cyclosporine is the main drug used for immunosupression among cardiac transplant patients and its blood levels can be measured at 0 and 2 hours after oral intake (C0 and C2 levels). Among kidney and liver transplants there are some data suggesting that C2 measurment is the most effective way of monitoring cyclosporine levels. However data about C2 monitorization and cardiac transplantation is limited.

Methods: During the period between May 1998 and May 2002, 18 patients underwent orthotophic heart transplantation and all patients recieved triple immunosupressive regiment (cyclosporine,azathiprine and corticosteroid) postoperatively. Cyclosorine levels were monitored with C0 measurements for the first 9 patients (Group I). C0 and C2 measurements were used for the last 9 patients (Group II). C0 and C2 drug levels were kept within 250-300 ng/ml and 1100-1300 ng/ml respectfully for the first 3 month then target levels were gradually reduced.

Results: Grade 1A to 3A acute rejection episodes were detected on endomyocardial biopsies among 6 patients (66%) monitored only with C0 measurements. In contrast only one grade 1A rejection episode was detected among patients monitored with both C0 and C2 measurements. However in this group there were patients who had normal C0 but elevated C2 levels in respect to the targeted values and these patients had serious cyclosporine side effects (44%) and infections (22%).

Conclusions: C2 monitorization for cyclosporine serum levels measurement among heart transplant recipients although provides ideal values for blood level arrengements, needs larger sample size studies in order to identify best target values.

Keywords : Heart transplantation, cyclosporine, immunosupression, endomyocardial biopsy
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