Microemulsion cyclosporine with C2 monitoring and tacrolimus in liver transplantation with or without hepatitis C virus infection

✍ Scribed by Ashok Jain

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 64 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20818

✦ Synopsis

The introduction of calcineurin inhibitors has improved graft survival in the last 25 years. [1][2][3] The superiority of tacrolimus over cyclosporine (CsA) was well established in preventing acute rejection and corticosteroid-resistant rejection from 3 large randomized trials after liver transplantation. However, these differences were studied with a conventional formulation of CsA and CsA monitoring with trough (C 0 ) concentrations. [4][5][6] In addition, in those three studies, the indication of hepatitis C virus (HCV)-related end-stage liver disease is relatively low: it accounts for more than 40% of liver transplantations in the United States. 7 It is now clear that C 2 monitoring of CsA better reflects the area under the concentration curve of the drug and has a better safety and efficacy profile in renal transplantation. 8,9 Also, the microemulsion formulation of CsA (CsA ME) provides more predictable area under the concentration curve, and day-to-day fluctuations in concentration are less common. In liver transplantation, diversion of bile affects the absorption of CsA, which is less affected with CsA ME formulation. [10][11][12][13][14][15][16] In vitro studies have shown anti-HCV activity of CsA at higher concentrations. 17,18 Thus, several questions emerge. Does microemulsion formulation of CsA with C 2 monitoring provides better safety and efficacy in liver transplant patients as compared with tacrolimus? And is there any benefit of CsA ME with C 2 monitoring over tacrolimus in HCV-positive patients undergoing liver transplantation? Both of these questions are important to clinicians in order to provide the best possible options for their patients.