A clinical assessment of mycophenolate drug monitoring after liver transplantation

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 & So...

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Published in:Clinical transplantation 2010-03, Vol.24 (2), p.E35-E42
Main Authors: Hwang, Shin, Lee, Sung-Gyu, Ahn, Chul-Soo, Kim, Ki-Hun, Moon, Deok-Bog, Ha, Tae-Yong, Song, Gi-Won, Jung, Dong-Hwan, Choi, Nam-Kyu, Kim, Kwan-Woo, Yu, Young-Dong, Park, Gil-Chun, Park, Pyoung-Jae, Choi, Young-Il
Format: Article
Language:English
Subjects:
Adult
Drug Monitoring
Drug Therapy, Combination
Female
Humans
immunosuppression
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - pharmacokinetics
Immunosuppressive Agents - therapeutic use
Liver Transplantation
Male
Middle Aged
mycophenolate mofetil
mycophenolic acid
Mycophenolic Acid - administration & dosage
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - pharmacokinetics
Mycophenolic Acid - therapeutic use
Postoperative Period
Tacrolimus - therapeutic use
therapeutic drug monitoring
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Summary: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. : 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 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.
ISSN:0902-0063
1399-0012
DOI:10.1111/j.1399-0012.2009.01166.x