The effect of MMF dose and trough levels on adverse effects in pediatric heart transplant recipients |
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| Authors: | Nida Siddiqi Jacqueline M. Lamour Daphne T. Hsu |
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| Affiliation: | 1. Department of Pharmacy, Children's Hospital at Montefiore, Bronx, NY, USA;2. Cardiology Division, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA |
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| Abstract: | Limited pharmacokinetic and safety data exist for MMF in pediatric HTR. Previously targeted MPA‐TL are 1.5–3.0 μg/mL. The objective of this study was to assess the outcomes targeting MPA‐TL of 0.8–2.0 μg/mL in pediatric HTR. MPA‐TL were retrospectively collected 2–12 months post‐transplant. Acute rejection, infection, leukopenia, and GI complaints were then correlated with MPA‐TL. A total of 355 MPA‐TL from 22 HTR were included. Median age was 2.5 yr. Primary indication for transplant was dilated cardiomyopathy (64%). Mean MPA‐TL was 1.7 ± 0.9 μg/mL. African American patients received significantly higher doses (702 ± 235 mg/m2) compared with other races (p = 0.035). Leukopenia was less common in patients with SUB MPA vs. others (p = 0.01). MMF was discontinued for GI complaints in one patient and leukopenia in two patients. One SUB patient had acute rejection, and one SUP patient had infection. One‐yr survival was 100%. Targeting a lower range for MPA‐TL was not associated with significant rejection or infection. Despite lower MPA‐TL, MMF was discontinued in 3/22 patients for adverse effects. |
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| Keywords: | cardiac transplantation mycophenolate mofetil pediatric heart transplant therapeutic drug monitoring |
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