Renal transplant patients at high risk of acute rejection benefit from adequate exposure to mycophenolic acid

Transplantation
Teun van GelderRichard D Mamelok

Abstract

To better define subpopulations in which achieving adequate mycophenolic acid (MPA) concentrations quickly would be important, a post hoc exploratory analysis on the fixed-dose concentration-controlled database was performed, comparing high- versus low-risk renal transplant patients. Renal transplant patients were treated with mycophenolate mofetil, corticosteroids, and cyclosporine A or tacrolimus. Patients were defined as "high risk" if they had one or more of the following characteristics: delayed graft function, second or third transplantation, panel reactive antibodies >15%, four or more human leukocyte antigen mismatches, or were of black race. A total of 549 patients (61%) were classified as high risk, of whom 284 were on cyclosporine A treatment and 265 on tacrolimus. In high-risk patients, the difference in rejection incidence was 14.3% in the MPA-area under the concentration (AUC) less than 30 mg hr/L vs. 7.8% in the MPA-AUC more than or equal to 30 mg hr/L groups (P=0.025) during the first month after transplantation; whereas, in low-risk patients, there were similar rejection rates (5.7% vs. 4.5%). In the subgroup of high-risk tacrolimus-treated patients, the difference in acute rejection incidence in the first mont...Continue Reading

References

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Citations

Oct 23, 2013·Medicine·Maged MuhammedEleftherios Mylonakis
May 26, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Sita GourishankarBryce A Kiberd
May 6, 2014·Archives of Toxicology·Christine E Staatz, Susan E Tett
Apr 14, 2015·Expert Opinion on Drug Metabolism & Toxicology·Louise M AndrewsTeun van Gelder
Mar 12, 2016·Transplantation Reviews·Johann PratschkeFriedrich Thaiss
Oct 8, 2015·Transplant International : Official Journal of the European Society for Organ Transplantation·Jeffrey J GaynorGeorge W Burke
Apr 6, 2013·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Z Daher AbdiA Rousseau
Mar 14, 2013·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·R BouamarT van Gelder
Oct 15, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·Yvon LebranchuPeter Friend
Oct 6, 2015·Pediatric Transplantation·Burkhard Tönshoff
Mar 12, 2015·Transplant International : Official Journal of the European Society for Organ Transplantation·Teun van Gelder, Dennis A Hesselink
Aug 8, 2018·Therapeutic Drug Monitoring·Rolf Anton KlaasenNils Tore Vethe
Jan 9, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Dirk R J KuypersUNKNOWN Transplantation Society (TTS) Consensus Group on TDM of MPA
May 28, 2019·International Journal of Clinical Pharmacy·Busaya KulabusayaKearkiat Praditpornsilpa
Aug 1, 2019·World Journal of Transplantation·Boonphiphop BoonphengWisit Cheungpasitporn
May 20, 2016·Transplant International : Official Journal of the European Society for Organ Transplantation·Samir J PatelA Osama Gaber
Jul 21, 2011·Clinical Pharmacology and Therapeutics·T van Gelder
Oct 19, 2016·British Journal of Clinical Pharmacology·Jiang-Tao TangTeun van Gelder
Oct 28, 2020·Expert Opinion on Drug Metabolism & Toxicology·Rasmus EhrenLutz T Weber

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