Abstract:

Objective To reduce the dosage of corticosteroids and to evaluate its efficiency and safety based on mycophenolate acid (MPA) therapeutic drug monitoring (TDM) and rational use of mycophenolate mofetil (MMF) for renal allograft recipients during the maintenance period of immunosuppressive therapy. Methods Eighty kidney transplant recipients who underwent CsA+MMF+Pred triple immunosuppressive therapy were selected and randomly divided into the MPA TDM group and control group. For patients of the MPA TDM group, the area under the plasma MPA concentration-time curve (MPA-AUC) was calculated by the simplified formula of limited sampling method. The dosage of MMF was adjusted according to the MPA-AUC, so the range of MPA-AUC_{0-12 h}  reached 30-60 mg·h-1·L-1 and the dosage of corticosteroid was reduced by at least 50%. For patients in the control group, relatively fixed dosage of MMF was used and the dosage of corticosteroids was not reduced. The incidence of graft rejection and various adverse reactions and the level of fasting blood glucose of two groups were compared. Results For patients of the MPA TDM group and control group, the differences of functions of the allograft, incidence of graft rejection and various adverse reactions, and the dosage of CsA and MMF were not statistically significant (P>0.05). Dosages of prednisone of the MPA TDM group and control group were (2.77±0.79) mg/d and (6.00±1.77)mg/d, respectively, and the difference was statistically significant (P<0.05). Fasting plasma glucose levels of the MPA TDM group and control group were (5.36±0.50) mmol/L and (5.78±1.19) mmol/L, and the difference was statistically significant (P<0.05). Conclusion For renal transplant recipients, the dosage of corticosteroids can be safely and effectively reduced based on the MPA TDM and rational use of MMF during the maintenance period of immunosuppressive therapy.

Key words: kidney transplantation, mycophenolate acid, therapeutic drug monitoring, corticosteroids, low dosage