Cyclosporine measurement by FPIA, PC-RIA, and HPLC following liver transplantation

Abstract

The factors affecting CyA dosing and kinetics in LT patients are complex, and have been thoroughly investigated and reviewed. Plasma or WB CyA concentration monitoring remains the best method presently available for adjusting CyA dosage in LT patients in a timely manner. The availability of an FPIA assay for CyA has produced rapid drug analysis for transplant patient monitoring, but adds additional factors that must be considered in interpreting CyA concentrations. Liver dysfunction may disproportionately elevate CyA plasma or blood levels when analyzed by FPIA in relation to PC-RIA or HPLC, and adjustment of the therapeutic range or analysis by a more specific assay method may be necessary for dosage adjustment in these patients. The availability of a more specific antibody in an FPIA assay may avert these problems, as would the development of immunologic monitoring techniques that provide a global assessment of immune suppression produced by increasingly complex immunosuppressive regimens in LT patients.

Fig 1

Serum bilirubin and plasma CyA concentrations over the 14-day postoperative period in patient 1. For the lower figure: ● = FPIA, ○ = PC-RIA, and ■ = HPLC.

Fig 2

Serum bilirubin, WB, and plasma CyA concentrations by FPIA and PC-RIA over the 14-day postoperative period in patient 11. For the CyA concentration figures: ● = FPIA and ○ = PC-RIA.