Monitoring of cyclosporine levels in transplant recipients using self-administered fingerprick sampling

Nizar Yonan, Ruth Martyszczuk, Ali Machaal, Anna Baynes, Brian G. Keevil

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Use of C2 monitoring for cyclosporine A (CsA) microemulsion results in improved clinical outcomes vs. trough (C0) monitoring. Logistical issues include accurate timing of the C2 sample; requirement for sample dilution with most standard assay techniques; and inconvenience for patients. Recently, it has been shown that CsA concentrations in capillary blood correlate closely with levels in venepuncture samples, and that liquid chromatography tandem mass spectrometry (LC-MS/MS) can analyse CsA concentration using undiluted capillary blood from fingerprick samples. In a study to assess the feasibility of CsA monitoring, 52 stable heart transplant patients were provided with kits to take fingerprick trough and C2 blood samples at home, returning them to the laboratory by post for LC-MS/MS analysis. In total, 225 samples were provided, of which 14 (6%) were unsuitable for analysis because of clotting (n = 10) or insuficient volume (n = 4). Discomfort was not a problem and initial dificulties that some patients reported in taking the samples resolved with experience. All samples were returned by the postal system in a timely manner. Use of fingerprick assays could allow transplant physicians to have access to C2 levels when patients visit the clinic for review, and avoids the need for patients to attend the clinic or local healthcare centre solely for venepuncture. A barrier to more widespread introduction of fingerprick testing is likely to be lack of suitable MS facilities and trained personnel. In conclusion, self-administered fingerprick testing for CsA blood levels is practical to implement and highly convenient for patients and offers advantages for the transplant team. Copyright © Blackwell Munksgaard 2006.
    Original languageEnglish
    Pages (from-to)221-225
    Number of pages4
    JournalClinical Transplantation
    Volume20
    Issue number2
    DOIs
    Publication statusPublished - Mar 2006

    Keywords

    • C2 monitoring
    • Cyclosporine
    • Fingerprick
    • Neoral

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