关键词: 心脏移植, 环孢霉素, C₀, C₂

Abstract: Objective The Cyclosporine was used first in 1980's and still remain the prominent immune inhibition medication after the heart transplantation world wide. The recent renal and liver transplantation researches imply that the conservative trough concentration monitoring method could not correlate well with the Cyclosporine metabolism features, researches in the heart transplantation recipients were still lacking especially in China. Our aim is to investigate the relative features among serial Cyclosporine concentrations at different time points after administration and the drug area under the dynamic metabolism distribution curve. As well as to compare the complications of C₀ and C₂ patient groups in Chinese heart recipients. Methods The SPSS 11.5 software was used to analyze the correlation coefficients between Cyclosporine concentration and drug metabolism area under the curve at 8 serial individual time points. The recent 26 heart transplantation recipients in our center were divided into C₀ and C₂ monitoring groups and the complication data 1 year after heart transplantation were compared. The acute immune rejection rates were also recorded. Results The weight, age, donor-recipient blood types and ischemic time between C₀ and C₂ groups were not different. And the two groups shared the same immune inhibition strategy: Cyclosporine, MMF and Pred. The C₂ concentration had better relation than C₀(r₂=0.68 vs r₀=0.38) and other points with the Cyclosporine AUC. There was significant difference in the C₂ concentrations between recipients with or without acute rejection(P=0.035). What is interesting is that there was no difference in C₀ level between the rejection group and the none-rejection group(P=0.257). There was less complications(hypertention, high creatine levelrglycemia, hyperlipemia) in the C₂ group than that in the C₀ group. There was no difference between the C₀ and C₀ groups in liver damage. There were 2 cases of infection, 1 in each group. One patient died of multiple organ failure after serious infection in the C₀ group and none died of infection in the C₂ group. There were 3 cases with acute immune rejection, 1 in the C₀ group and 2 in the C₂ group. Two patients died of low cardiac output after the rejection reaction in the C₀ group and none died of the rejection in the C₂ group. Conclusion C₂ concentration correlates better than those of the C₀ and other time points in the Cyclosporine metabolism dynamic distribution. C₂ monitoring method could diminish Cyclosporine medication in many recipients after heart transplantation. Our data shows that C₂ monitoring therapy is simple and effective for the Chinese heart transplantation recipients.

Key words: heart transplantation, cyclosporine, C₀, C₂