Mycophenolic Acid Plasma Trough Level: Correlation with Clinical Outcome

摘要

Objectives: Assess the relationship between clinical diagnosis, state of immunosuppression, mycophenolic?acid (MPA) plasma trough levels (MPAC min ), and mycophenolate mofetil (MMF) dosage in renal transplant?recipients. Materials and Methods: MPAC min were determined in 30 kidney transplant patients, of whom 7 exhibited?biopsy-proven acute rejection. The remaining 23 had normal graft function. Graft outcome, defined by?clinical diagnosis and serum creatinine level, was compared according to MPAC min , MMF dosage, and total?lymphocyte count (LC). Results: Patients with acute rejection had similar MPAC min (2.4 ± 1.7 μg/mL), MMF dosages (1.7 ± 0.5 g), and?LCs (0.001165 ± 0.0040 x 109/L) when compared with normal patients (2.2 ± 0.7 μg/mL, 1.7 ± 0.4 g and?0.001160 ± 0.00527 x 109/L) respectively. Rejection rates were comparable irrespective of MPAC min ranges and?higher in those receiving the 1-g dose (30%) when compared with those receiving 1.5-g and 2-g doses (12.5%?and 11.7%). No relationship was observed between MPAC min and MMF doses, and neither parameter correlated?with LC. Conclusions: These results suggest that MPAC min is a poor correlate of clinical outcome and state of?immunosuppression. Although the usually recommended dosage of MMF (2 g) may be associated with acute?rejection, low-dose MMF (1 g) seems to constitute a higher risk.