Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Clinical Investigation
Relationship Between Acute Rejection and Cyclosporine or Mycophenolic Acid Levels in Japanese Heart Transplantation
Kyoichi WadaMitsutaka TakadaTakashi UedaHiroyuki OchiTakeshi KotakeHideki MorishitaAkihisa HanataniTakeshi Nakatani
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2007 Volume 71 Issue 3 Pages 289-293

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Abstract

Background Cyclosporine (CsA), Mycophenolate mofetil (MMF) and prednisolone (PSL) are widely used for the prevention of acute rejection after heart transplantation. Recently, the serum concentration - time curves (AUC) of CsA and MMF have been demonstrated to be precise predictors of acute rejection. Methods and Results Fourteen heart transplant patients were treated concomitantly with CsA, MMF, and PSL between May 1999 and November 2005 at the National Cardiovascular Center and of them 3 had acute rejection episodes [International Society for Heart & Lung Transplantation grade 3a]. Two patients (man in his 30 s; woman in her 40 s) had acute rejection with a mycophenolic acid (MPA) AUC0-12 h <30 μg · h · ml-1 and low CsA AUC (AUC0-4 h; 2,408 ng · h · ml-1, 1,735 ng · h · ml-1). However, 1 patient (man in his 30 s) with a high CsA AUC0-4 h (4,019 ng · h · ml-1) did not develop cardiac allograft rejection even if the MMF was temporarily stopped. These 3 patients were investigated to evaluate the relationship between acute rejection and pharmacokinetic parameters, including the CsA C0, C2, AUC0-4 h and MPA AUC0-12 h. Conclusions The findings suggest that a high CsA AUC0-4 h may prevent rejection of a cardiac allograft, even if MMF is stopped or drastically reduced. (Circ J 2007; 71: 289 - 293)

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© 2007 THE JAPANESE CIRCULATION SOCIETY
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