| Kidney transplantation is an effective method for patients with end-stage renal failure. Along with the constant development of immunosuppressive drugs, kidney transplant recipients / kidney survival rate was significantly increased. cyclosporine is currently the most widely used immunosuppressant drug after organ transplantation. However, because of its narrow therapeutic window, bioavailability and pharmacokinetics individual differences, and the plasma concentrations were not only dose-dependent relationship with the immunosuppressive effects intensity, but also with the liver and kidney toxicity.So selecting effective and sensitive method to monitor cyclosporine blood concentration for patients taking this drug ,then adjustment dosage based on plasma concentration is essential.The pharmacokinetic of cyclosporine and clinical studies indicate that area under the concentration-time curve (AUC) can accurately reflect the entire process pharmacokinetics of cyclosporine in vivo, and closely related to clinical drug efficacy andtoxicity,so AUC is the best way to monitor treatment of this drug, but because of its operations is so complicated and expensive, it's difficult to use in clinical practice. So monitoring of AUC was often taken place by monitoring of single-point concentration.Previously, most transplant centers used to monitor the valley concentration of cyclosporine C0 to adjust the dosage. In recent years, domestic and foreign study found that the peak concentration of cyclosporine medication C2 has better correlation with AUC0-4 compared with the C0. Adjusting the dosage of cyclosporine according C2 can reduce the incidence of acute rejection, reducethe degree of rejection, suggest to the poisoning dose and reduce acute liver and kidney poisoning rate compared with the C0.[Objective] Investigating the clinical significance that monitor peak plasma concentration C2 and valley concentration C0 to determinant the anti-rejection drug efficacy and side effect of cyclosporine for early postoperative of renal transplant patients taking cyclosporine.[Methods] By retrospective analysising 78 recipients who use cyclosporine as based immunosuppressant in China-Japan Union Hospital of Jilin University during June 2003 to April 2006, monitoring trough concentrations C0 and peak concentrations C2 degrees by monoclonal antibody fluorescence polarization (TDX) within six months after renal transplantation,a total of 996 times,comparative study the significance of C0 and C2 for forecasting early acute rejection and acute liver toxicity and nephrotoxicity after renal transplantation.[Results ] In this group during the period of observation, 50 cases didn't occurred acute rejection ,acute liver toxicity nor kidney toxicity. 16 cases occurred acute rejection , of which ten cases within the frist month, four case between the second to the third month, two cases between the fourth to the sixth month. During the first month after renal transplantation,the valley concentrations C0 of acute rejection group was not statistical different compared with normal group (P> 0.05 ). The valley concentrations C0 of liver toxicity or kidney toxicity group was significant different compared withnormal group(P <0.01). The peak concentrations C2 of acute rejection group, liver toxicity group and kidney toxicity group were significant different compared with normal group(P <0.01). From the second month to the third month, the valley concentrations C0 of acute rejection group was not statistical different compared with normal group (P> 0.05 ). The valley concentrations C0 of liver toxicity or kidney toxicity group was significant different compared with normal group(P <0.01). The peak concentrations C2 of acute rejection group, liver toxicity group and kidney toxicity group were significant different compared with normal group(P <0.01). From the fourth month to the sixth month, the valley concentrations C0 of acute rejection group was not statistical different compared with normal group (P> 0.05 ). The valley concentrations C0 of liver toxicity or kidney toxicity group was significant different compared with normal group(P <0.01). The peak concentrations C2 of acute rejection group, liver toxicity group and kidney toxicity group were significant different compared with normal group(P <0.01). In addition, the concentrations C0 of two recipients were within the recommended therapeutic window during the first month after renaltransplantation,but the concentrations C2 were significantly lower than the average level of normal group.The concentrations C2 has not measured up markedly after increasing the dosage of cyclosporine,then acute rejection occurred subsequently.After replaced cyclosporine by tacrolimus, acute rejection had been reversed.[Conclusion] Monitoring valley concentration of cyclosporine C0 can not predict the occurrence of acute rejection after renal transplantation. Monitoring peak concentration of cyclosporine C2 can predict the occurrence of acute rejection after renal transplantation effectively. Monitoring valley concentration of cyclosporine C0 and peak concentration of cyclosporine C2 can both predict the occurrence of liver and kidney toxicity,but C2 is more sensitive than C0.Early postoperative monitoring of cyclosporine blood concentration of cyclosporine C2 can discover absorption cases promptly and prevent the occurrence of acute rejection after renal transplantation effectively.
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