Cyclosporine minimization and cost reduction in renal transplant recipients recieving a C2-monitored, cyclosporin-based quadruple immunosuppressive regimen

Karen L. Hardinger, Mark A. Schnitzler, Matthew J. Koch, Decha Enkvetchakul, Niraj Desai, Martin Jendrisak, Jeffrey A. Lowell, Brent Miller, Surendra Shenoy, Daniel C. Brennan

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background. Targeting 2-hr postdose cyclosporine (C2) levels to 1,000 to 1,700 mg/dL during the first 6 months after renal transplantation is recommended for triple immunosuppressive regimens. This trial determines whether lower C2 levels could be targeted safely in de novo kidney transplant recipients under a quadruple regimen compared with a similar cohort monitored with trough (CO) levels. Methods. This single-center, sequential, cohort-designed trial included patients who received Thymoglobulin, corticosteroids, an antimetabolite, and cyclosporine monitored by C2 (n=50) or C0 (n=50). Cyclosporine was tapered to maintain the C2 between 1,000 and 1,200 ng/mL months O to 3 and between 600 and 1,000 ng/mL thereafter and C0 between 250 and 350 ng/mL months 0 to 3 and between 100 and 250 ng/mL thereafter. Results. Baseline patient and donor characteristics were similar. There were no differences in graft survival (100% C2 vs. 100% C0), acute rejection (4% C2 vs. 6% C0), allograft function, or adverse events at 6 months. C2 levels were lower than the suggested guidelines throughout the study (33% lower at 1 month and 48% lower at 6 months). Lower cyclosporine doses were achieved in the C2 arm compared with the C0 arm by 1 month and were sustained throughout the trial, which translated into an average cyclosporine cost savings of $773 in the C2 arm during the 6-month period (P<0.001). Conclusion. With a quadruple immunosuppressive regimen and lower C2 targets than recommended for triple therapy, safe and effective cyclosporine minimization was achieved. Lower cyclosporine doses were achieved in C2-monitored patients compared with CO-monitored patients, translating into lower immunosuppressive costs.

Original languageEnglish
Pages (from-to)1198-1203
Number of pages6
JournalTransplantation
Volume78
Issue number8
DOIs
StatePublished - Oct 27 2004

Keywords

  • Cyclosporine
  • Drug monitoring
  • Outcomes
  • Thymoglobulin

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