Cyclosporine Lymphocyte Maximum Level Monitoring in De Novo Kidney Transplant Patients: A Prospective Study

Abstract

Objectives: To determine prospectively the temporal variations of cyclosporine-A lymphocyte maximum level, whole blood maximum concentration, and total lymphocyte count in patients with de novo kidney transplantation.

Materials and Methods: Lymphocyte maximum level, whole blood maximum concentration, and total lymphocyte count were prospectively measured in 35 patients at 1, 2, and 3 months after kidney transplantation. Two groups—a biopsy-proven acute rejection group (REJ+) and a rejection-free group (REJ-)—were compared.

Results: Both groups had similar lymphocyte maximum levels, whole blood maximum concentrations, and total lymphocyte counts at the first month after transplantation. REJ+ patients had significantly lower lymphocyte maximum levels at 2 and 3 months (59 ± 34 and 33 ± 9 pg/Lc) and higher total lymphocyte counts (0.00204 ± 0.00078 x 109/L and 0.00203 ± 0.00022 x 109/L) when compared with their REJ- counterparts (87 ± 56 and 63 ± 30 pg/Lc, P < .05 and P < .007) and (0.00137 ± 0.00074 x 109/L and 0.0015 ± 0.0006 x 109/L, P < .02 and P < .003) respectively. Whole blood maximum concentrations were significantly higher in patients in the REJ+ group (2050 ± 623 vs 1414 ± 536 ng/mL, P < .02) at 2 months. At 3 months, the 2 groups were comparable (1158 ± 340 vs 1365 ± 525 ng/mL, P = NS).

Conclusions: These results suggest that acute rejection is associated with a relatively low cyclosporine-A lymphocyte maximum level and high total lymphocyte count in the early posttransplant period. Cyclosporine-A whole blood maximum concentration failed to correlate with clinical outcome. Cyclosporine-A lymphocyte maximum level seems to offer a more reliable alternative than does whole blood maximum concentration for cyclosporine-A monitoring in patients with kidney transplantation.