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Villamil et al. have provided a useful distinction when a transplant physician faces a low C2 value in the immediate port-transplant period, between poor absorption versus delayed but adequate CsA absorption. This distinction should prevent the risk of CsA toxicity when the underlying problem is delayed but adequate absorption. Eleven of 12 delayed absorbers had a peak CsA concentration at C 4 . They propose measurement of C 4 in addition to C 2 . They also observed that mean C 0 was significantly higher among delayed absorbers. Lastly, they also observed that the condition of delayed absorption of CsA is transient and resolves in all the patients of their series within the first three weeks after transplantation. This is a potentially important clinical observation that needs confirmation in larger number of patients.
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