A clinical assessment of mycophenolate drug monitoring after liver transplantation |
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Authors: | Shin Hwang Sung‐Gyu Lee Chul‐Soo Ahn Ki‐Hun Kim Deok‐Bog Moon Tae‐Yong Ha Gi‐Won Song Dong‐Hwan Jung Nam‐Kyu Choi Kwan‐Woo Kim Young‐Dong Yu Gil‐Chun Park Pyoung‐Jae Park Young‐Il Choi |
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Institution: | Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea |
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Abstract: | 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. A clinical assessment of mycophenolate drug monitoring after liver transplantation.Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x© 2010 John Wiley & Sons A/S. 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. |
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Keywords: | immunosuppression liver transplantation mycophenolate mofetil mycophenolic acid therapeutic drug monitoring |
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