Key result
Cyclosporine 2-h post-dose levels did not differ by biopsy score overall, but during the first month, scores ≤2 trended with higher mean C2 than scores ≥3A.
Why the study?
Is there a relationship between cyclosporine 2-h post-dose levels and endomyocardial biopsy rejection scores in heart transplant patients receiving ATG induction?
Cohort (n=39)
Is there a relationship between cyclosporine 2-h post-dose levels and endomyocardial biopsy rejection scores in heart transplant patients receiving ATG induction?
Answers are grounded in this paper and cite their sources.
Cyclosporine 2-h post-dose levels do not significantly correlate with endomyocardial biopsy rejection scores overall in heart transplant patients receiving ATG induction, though higher levels may be associated with lower rejection scores in the first month.
BACKGROUND: Cyclosporine (CsA) 2-h post-dose levels (C(2)) correlate better with the area-under-the-curve compared with trough levels. The purpose of this study was to determine the relationship between C(2) and endomyocardial biopsy (EMB) score in heart transplant patients receiving anti-thymocyte globulin (ATG)-induction. METHODS: We reviewed 517 EMB performed during the first year in 39 adult heart transplant patients receiving ATG-induction, corticosteroids, mycophenolate mofetil and CsA. C(2) obtained on the day of EMB was related to the International Society for Heart and Lung Transplantation classification (score </=2 or >/=3A). Furthermore, EMB were related to C(2) (ng/mL), sorted according to the lower recommended range in liver (0-3 months: 850; 4-6 months: 700; 7-12 months: 500) or renal transplantation (0-1 month: 1500; 2-3 months: 1200; 4-6 months: 1000; 7-12 months: 800). RESULTS: Overall, C(2) did not significantly differ in patients with EMB </=2 or >/=3A. However, during the first month, EMB </=2 was associated with a trend towards a higher mean C(2) compared with EMB >/=3A (750 ng/mL vs. 530 ng/mL). When C(2) were sorted according to the lower recommended range in liver or renal transplantation, no significant difference was observed when EMB was </=2 or >/=3A. CONCLUSIONS: In heart transplant patients receiving ATG-induction, C(2) did not significantly differ according to EMB </=2 or >/=3A. No significant relationship was found between EMB score and C(2) based on the lower recommended range in liver or renal transplantation. However, mean C(2) >750 ng/mL appears to be associated with a lower rejection score during the first month.
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Cantarovich et al. (2004) conducted a cohort in Heart transplant (n=39). Cyclosporine 2-h post-dose levels (C2) was evaluated on Endomyocardial biopsy (EMB) score (≤2 or ≥3A). Cyclosporine 2-h post-dose levels did not differ by biopsy score overall, but during the first month, scores ≤2 trended with higher mean C2 than scores ≥3A.
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