Cyclosporine monitoring in organ transplantation: Do we need a new concept?

Although the introduction of cyclosporine (CyA) in the 1980s as maintenance immunosuppressive regimen in solid organ transplantation (1) revolutionized this field, the therapeutic drug monitoring (TDM) of CyA to optimize efficacy and safety is still of clinical interest. During last 3 decades, no consensus has been attained yet on the criteria to derive benefit from the immunosuppressive efficacy, while limiting the side effects of CyA (2). As in clinical experiences, no relationship could be found between administered doses and clinical effects, fixed doses of CyA were not the best way to use the drug. To avoid side-effects, therefore, monitoring of CyA blood level is mandatory to modify the individual doses of the drug. CyA exposure, as calculated by area under the curve (AUC), has been shown to correlate with clinical outcomes in kidney transplant recipients