Project 3

Does C2 monitoring in organ transplant recipients demonstrate clinical benefit when compared with trough monitoring: a systematic review

Since the introduction of the microemulsion formulation of cyclosporine, there has been much interest in developing a method of monitoring cyclosporine blood levels that better reflects clinical outcomes when compared with traditional trough monitoring. Many studies have investigated the application of adjusting the dose according to 2-hour (C2) blood levels, with very variable results. This review systematically searched and appraised the literature in order to determine the clinical impact of C2 monitoring in renal, liver, cardiac, lung and pancreas transplantation.

The project is now complete and has been published, eventually concluding that in de novo transplant patients, there is little evidence from prospective studies to support the theoretical benefits of C2 monitoring. Potential dose reductions in stable patients may reduce costs, but no short-term clinical benefit is seen. Quality of studies in this area is poor, and the practical limitations of C2 monitoring mean that further evidence is required before a strategy for the administration of cyclosporine based on C2 levels can be recommended.

For the full results of this review, please read the full paper :

Knight SR and Morris PJ. The Clinical Benefits of Cyclosporine C2-Level Monitoring: A Systematic Review. Transplantation 2007; 83(12) : 1525