Mehmet Ali ÖZATİK, Haşmet BARDAKÇI, Oğuz TAŞDEMİR, Deniz Süha KÜÇÜKAKSU, Şeref KÜÇÜKER, Onurcan TARCAN, Mustafa BALCI, Erol ŞENER

Kalp translantasyonu sonrası immunsupressif tedavide siklosporin düzeyinin monitorizasyonu ve önemi

Amaç: Siklosporin kalp transplantasyonu sonrası immunsupressif tedavide kulanılan temel ilaç olup, doz monitorizasyonu 0. ve 2. saatlerde bakılan kan düzeyi ile yapılmaktadır. Böbrek ve karaciğer transplantasyonu yapılan hastalarda etkin kan düzeyinin 2. saatte bakılan düzey olduğu bildirilmekle birlikte, kalp nakli yapılan hastalarda bu konudaki veriler kısıtlıdır. Materyal ve Metod: Kliniğimizde Mayıs 1998 - Mayıs 2002 tarihleri arasında 18 hastaya ortotopik kalp transplantasyonu gerçekleştirildi ve tüm hastalara üçlü immunsupressif (siklosporin, azatioprin, kortikosteroid) tedavi başlandı. Siklosporin kan düzeyi takibi ilk 9 hastada 0. saat (C0) monitorizasyonu ile son 9 hastada ise C0 ve 2. saat (C2) monitorizasyonu ile gerçekleştirildi. Hastalarda ilaç dozları ilk 3 ay için C0 250-300ng/ml, C2 1100-1300 ng/ml olacak şekilde ayarlandı ve daha sonra giderek azaltıldı. Bulgular: Sadece C0 takibi yapılan hastalardan 6'sında endomiyokardiyal biyopsi kontrollerinde grade 1A -3A arasında değişen akut rejeksiyon bulgusu görülürken (%66), C0 ve C2 takibi birlikte yapılan grupta sadece 1 hastada grade 1A rejeksiyon saptandı. Ancak C0 düzeyleri istenen seviyelerdeyken C2 düzeyi hedeflenen düzeyi aşan hastalarda siklosporin yan etkileri (%44) ve ciddi enfeksiyon (%22) saptandı. Sonuç: Kalp transplantasyonu yapılan hastalarda siklosporin tedavisinde C2 monitorizasyonu ideal kan düzeyini göstermekle birlikte yeterli hedef düzeyini saptamada daha geniş çalışmalara gereksinim vardır.

Cyclosporine monitorization and its importance in immunosupressive treatment after cardiac transplantation

Background: Cyclosporine is the main drug used for immunosupression among cardiac transplant patients and its blood levels can be measured at 0 and 2 hours after oral intake (C0 and C2 levels). Among kidney and liver transplants there are some data suggesting that C2 measurment is the most effective way of monitoring cyclosporine levels. However data about C2 monitorization and cardiac transplantation is limited. Methods: During the period between May 1998 and May 2002, 18 patients underwent orthotophic heart transplantation and all patients recieved triple immunosupressive regiment (cyclosporine,azathiprine and corticosteroid) postoperatively. Cyclosorine levels were monitored with C0 measurements for the first 9 patients (Group I). C0 and C2 measurements were used for the last 9 patients (Group II). C0 and C2 drug levels were kept within 250-300 ng/ml and 1100-1300 ng/ml respectfully for the first 3 month then target levels were gradually reduced. Results: Grade 1A to 3A acute rejection episodes were detected on endomyocardial biopsies among 6 patients (66%) monitored only with C0 measurements. In contrast only one grade 1A rejection episode was detected among patients monitored with both C0 and C2 measurements. However in this group there were patients who had normal C0 but elevated C2 levels in respect to the targeted values and these patients had serious cyclosporine side effects (44%) and infections (22%). Conclusions: C2 monitorization for cyclosporine serum levels measurement among heart transplant recipients although provides ideal values for blood level arrengements, needs larger sample size studies in order to identify best target values.

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