›› 2012, Vol. 32 ›› Issue (6): 788-.doi: 10.3969/j.issn.1674-8115.2012.06.021

• Original article (Clinical research) • Previous Articles     Next Articles

Relationship between mycophenolate mofetil dose and mycophenolate acid exposure in renal allograft recipients during maintenance immunosuppressive therapy

AN Hui-min, ZHOU Pei-jun, XU Da, WANG Xiang-hui, SHAO Kun   

  1. Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2012-06-28 Published:2012-07-02

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Abstract:

Objective To investigate the level of mycophenolate acid (MPA) exposure in renal allograft recipients receiving mycophenolate mofetil (MMF) as maintenance immunosuppressive therapy. Methods Sixty renal allograft recipients were treated with cyclosporine A (CsA), MMF and prednisone (Pred), peripheral vein blood samples were obtained 0.5 h, 2 h and 4 h after administration of MMF, the plasma concentrations of MPA were measured by enzyme-multiplied immunoassay technique. The values of area under the curve (AUC) of plasma MPA concentration (MPA AUC) of the renal allograft recipients were calculated by the simplified formula of limited sampling strategy. All recipients were divided into low dose MMF group (MMF＜1.5 g/d，n=18）, recommendation dose group （MMF＝1.5 g/d，n=29） and high dose MMF group （MMF＞1.5 g/d，n=13） according to doses of oral administration of MMF. Besides, all recipients were divided into low exposure to MPA group (MPA AUC＜30 mg·h·L－1), target exposure to MPA group (MPA AUC= 30-60 mg·h·L－1) and high exposure to MPA group (MPA AUC＞60 mg·h·L－1) according to values of MPA AUC. Results The mean MPA AUC of 60 renal transplant recipients was (59.83±19.42) mg·h·L－1. There were 3 cases (5.0%) in low exposure to MPA group, 31 cases (51.7%) in target exposure to MPA group and 26 cases (43.3%) in high exposure to MPA group. The mean doses of CsA in low exposure to MPA group, target exposure to MPA group and high exposure to MPA group were (166.67±14.43) mg/d, (137.10±41.27) mg/d and (128.85±37.88) mg/d respectively, exhibiting a decreasing tendency, while there was no significant difference among groups （P>0.05）. Conclusion Under the condition of MMF dose adjustment based on clinical events without MPA AUC monitoring, MPA tends to be highly exposed in renal allograft recipients. There are significant inter-individual variations in MPA pharmacokinetics, and it is necessary to perform MMF monitoring in treatment for renal allograft recipients.

Key words: renal transplantation, maintenance immunosuppressive therapy, mycophenolate mofetil, mycophenolate acid exposure, therapeutic drug monitoring