A clinical assessment of mycophenolate drug monitoring after liver transplantation
- Authors
- Hwang S.; Lee S.-G.; Ahn C.-S.; Kim K.-H.; Moon D.-B.; Ha T.-Y.; Song G.-W.; Jung D.-H.; Choi N.-K.; Kim K.-W.; Yu Y.-D.; Park G.-C.; Park P.-J.; Choi Y.-I.
- Issue Date
- 2010
- Keywords
- Immunosuppression; Liver transplantation; Mycophenolate mofetil; Mycophenolic acid; Therapeutic drug monitoring
- Citation
- Clinical Transplantation, v.24, no.2, pp E35 - E42
- Indexed
- SCI
SCIE
SCOPUS
- Journal Title
- Clinical Transplantation
- Volume
- 24
- Number
- 2
- Start Page
- E35
- End Page
- E42
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/15481
- DOI
- 10.1111/j.1399-0012.2009.01166.x
- ISSN
- 0902-0063
1399-0012
- Abstract
- Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF). Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it. Methods: A series of short-term prospective studies on TDM for MPA and/or tacrolimus was performed at a large-volume center. Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus-MMF therapy (n = 270), MMF-minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus-MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF-minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p < 0.001), in which r2 was fluctuating from 0.056 to 0.213 according to the post-transplant period over five yr; wide intraindividual variation was also observed during the first two months (n = 12, r2 < 0.2, p > 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF-minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%. Conclusion: MPA TDM-based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation. © 2010 John Wiley & Sons A/S.
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Collections - 2. Clinical Science > Department of Hepato-Biliary-Pancreatic Surgery > 1. Journal Articles
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