The Study On Correlativity Between Ciclosporin Concentration In Blood And Acute Rejection Posttransplantation

Objective:To investgate the correlation between 12-h CSA trough levels and the occurrence of acute rejection in the patients on a CSA based immunosuppression regimen after renal transplantation.and to explore the clinical significance of single-point target concentration for the 12-h CSA trough levels in evaluating acute rejection following renal transplantation.Methods:From January 2004 to December 2006,in the First Affiliated Hospital of Zhejiang University,A total of 341 recipients of a cadaveric kidney graft were enrolled.All of them received triple imununosupressive regimen composed of mycophenolate mofetil(MMF),cyclosporin and prednisone after operation.The pations were devivded as normal group and acute rejection group according to weather suffering acute rejection in the first month posttransplantation.Compare the differences of 12-h CSA trough levels between the two groups.Other donor and recipient Variables with a potential impact on acute rejection were analyzed:recipient demographics(age, gender,primary disease,and cold ischemic time,warm ischemic time,CMV serology,HLAmismatch and panel reactive antibody sensitization,lymphatic drug testing);total daily CSA dose (individual CSA dose multiplied by dosing frequency);Result:23 patiants suffered acute rejection in the first month posttransplantation.The association of CSA levels and other clinical variables with acute rejection was analyzed by population averaged logistic regression.CSA levels in patients experiencing acute rejection were compared to median CSA levels in patients free from acute rejection at the equivalent time periods post-transplantation.Time periods chosen were:week 2,week 3,week 4.And there are diffrences between the two groups,287.6±109.1 umol/l and 209.45±69.38umol/l(p=0.00899)in the second week,369.6±104.6,mol/l and 305.84±63.52umol/l(p=0.01317)in the third week,356.2±79.7and 301.03±54.68umol/l(p=0.045)in the forth week. ROC analysis showed a median 12-h trough CSA level of 254.38umol/l,323.18umol/l,332.74umol/l best discriminated patients with and without acute rejection in the second week,third week,forth week.About other clinical variables,there are no difference between the two groups. Conclusion:Acute rejection within second week,third week,forth week posttransplantation was associated with lower CSA levels.An CSA level of 254.38umol/l,323.18umol/l,332.74umol/l best discriminates patients with and without rejection in the second week,third week,forth week after operation...