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논문 기본 정보

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학술저널
저자정보
Jung Hee-Yeon (Department of Internal Medicine School of Medicine Kyungpook National University Kyungpook National) Lee Sukyung (Department of Internal Medicine Pohang St. Mary's Hospital Pohang Republic of Korea.) Jeon Yena (Department of Statistics College of Natural Sciences Kyungpook National University Daegu Republic o) Choi Ji-Young (Department of Internal Medicine School of Medicine Kyungpook National University Kyungpook National) Cho Jang-Hee (Department of Internal Medicine School of Medicine Kyungpook National University Kyungpook National) Park Sun-Hee (Department of Internal Medicine School of Medicine Kyungpook National University Kyungpook National) Kim Yong-Lim (Department of Internal Medicine School of Medicine Kyungpook National University Kyungpook National) Kim Hyung-Kee (Department of Surgery School of Medicine Kyungpook National University Kyungpook National Universit) Huh Seung (Department of Surgery School of Medicine Kyungpook National University Kyungpook National Universit) Won Dong Il (Department of Clinical Pathology School of Medicine Kyungpook National University Kyungpook Nationa) 김찬덕 (경북대학교)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.35 No.24
발행연도
2020.1
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1 - 10 (10page)

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Background: Little is known regarding the safe fixed dose of mycophenolic acid (MPA) for preventing biopsy-proven acute rejection (BPAR) in kidney transplant recipients (KTRs). We investigated the correlation of MPA trough concentration (MPA C0) and dose with renal transplant outcomes and adverse events. Methods: This study included 79 consecutive KTRs who received MPA with tacrolimus (TAC) and corticosteroids. The MPA C0 of all the enrolled KTRs was measured, which was determined monthly by using particle-enhanced turbidimetric inhibition immunoassay for 12 months, and clinical data were collected at each time point. The clinical endpoints included BPAR, any cytopenia, and BK or cytomegalovirus infections. Results: No differences in MPA C0 and dose were observed between KTRs with or without BPAR or viral infections under statistically comparable TAC concentrations. MPA C0 was significantly higher in patients with leukopenia (P = 0.021) and anemia (P = 0.002) compared with those without cytopenia. The MPA dose was significantly higher in patients with thrombocytopenia (P = 0.002) compared with those without thrombocytopenia. MPA C0 ≥ 3.5 µg/mL was an independent risk factor for leukopenia (adjusted odds ratio [AOR], 3.80; 95% confidence interval [CI], 1.24–11.64; P = 0.019) and anemia (AOR, 5.90; 95% CI, 1.27–27.51; P = 0.024). An MPA dose greater than the mean value of 1,188.8 mg/day was an independent risk factor for thrombocytopenia (AOR, 3.83; 95% CI, 1.15–12.78; P = 0.029). However, an MPA dose less than the mean value of 1,137.3 mg/day did not increase the risk of BPAR. Conclusion: Either a higher MPA C0 or dose is associated with an increased risk of cytopenia, but neither a lower MPA C0 nor dose is associated with BPAR within the first year of transplantation. Hence, a reduced MPA dose with TAC and corticosteroids might be safe in terms of reducing hematologic abnormalities without causing rejection.
#Mycophenolic Acid #Kidney Transplantation #Drug Monitoring #Dose #Graft Rejection

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참고문헌 (26)

참고문헌 신청
Ransom JT / 1995 / Mechanism of action of mycophenolate mofetil / Ther Drug Monit 17(6):681~684 google schola Staatz CE / 2007 / Clinical pharmacokinetics and pharmacodynamics of mycophenolate in solid organ transplant recipients / Clin Pharmacokinet 46(1):13~58 google schola Shaw LM / 2003 / Mycophenolic acid pharmacodynamics and pharmacokinetics provide a basis for rational monitoring strategies / Am J Transplant 3(5):534~542 google schola van Gelder T / 1999 / A randomized double-blind, multicenter plasma concentration controlled study of the safety and efficacy of oral mycophenolate mofetil for the prevention of acute rejection after kidney transplantation / Transplantation 68(2):261~266 google schola Le Meur Y / 2007 / Individualized mycophenolate mofetil dosing based on drug exposure significantly improves patient outcomes after renal transplantation / Am J Transplant 7(11):2496~2503 google schola

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