Therapeutic Monitoring of Mycophenolate in Transplantation: Is It Justified?

Barraclough, Katherine A.; Staatz, C. E.; Isbel, Nicole M.; Johnson, David W.

doi:10.2174/138920009787522205

Cited by 33 publications

(30 citation statements)

References 75 publications

(141 reference statements)

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“…In this study, the incidence of DGF was 19.1%. Previous studies showed that MPA exposure decreased in patients with DGF [17,18]. Owing to nephrotoxicity, high exposure to calcineurin inhibitors (cyclosporine or tacrolimus) was restricted in patients with DGF [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Intensified Dosage Regimen of Mycophenolic Acid is Associated with Less Acute Rejection in Kidney Transplantation from Donation after Circulatory Death

et al. 2018

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Introduction: Whether an early, short-term, adequate exposure to mycophenolic acid (MPA) under tacrolimus-based immunosuppression regimen in kidney transplantation from donation after circulatory death (DCD) was effective and safe is yet unknown. Material and Methods: The study was a single-center, retrospective, cohort study of DCD transplantation in China. Intensified and standard dosage regimens of enteric-coated mycophenolate sodium (EC-MPS) were week 1, 2,160 vs. 1,440 mg/day. The incidences of biopsy-proven acute rejection (BPAR), delayed graft function, infection, and patient and graft survival were compared between the 2 groups. Results: A total of 209 patients (n = 82 in intensified group and n = 127 in standard group) were enrolled from August 2013 to December 2014. The incidence of BPAR at 12 months was significantly lower in the intensified group as compared to that of the standard group. (2.4 vs. 10.2%, p = 0.035). The mean MPA area under curve (AUC) levels at day 7 was significantly higher in the intensified group than that in the standard group (66.18 ± 35.48 vs. 45.30 ± 23.5 mg·h/L, p < 0.001). MPA AUC levels were significantly decreased in patients with BPAR as compared to those with NO-BPAR. Conclusion: An early, short-term regimen of intensified EC-MPS with tacrolimus increased early MPA exposure and achieved a low rate of BPAR in kidney transplantation from DCD.

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Section: Discussionmentioning

confidence: 99%

Short-Term Intensified Dosage Regimen of Mycophenolic Acid is Associated with Less Acute Rejection in Kidney Transplantation from Donation after Circulatory Death

et al. 2018

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“…4 Moreover, the evidence supporting the utility of therapeutic drug monitoring of agents other than calcineurin inhibitors and mammalian target of rapamycin inhibitors remains less conclusive. 5, 6 …”

mentioning

confidence: 99%

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

2014

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Infectious complications remain a leading cause of morbidity and mortality after solid organ transplantation (SOT), and largely depend on the net state of immunosuppression achieved with current regimens. Cytomegalovirus (CMV) is a major opportunistic viral pathogen in this setting. The application of strategies of immunological monitoring in SOT recipients would allow tailoring of immunosuppression and prophylaxis practices according to the individual's actual risk of infection. Immune monitoring may be pathogen-specific or nonspecific. Nonspecific immune monitoring may rely on either the quantification of peripheral blood biomarkers that reflect the status of a given arm of the immune response (serum immunoglobulins and complement factors, lymphocyte sub-populations, soluble form of CD30), or on the functional assessment of T-cell responsiveness (release of intracellular adenosine triphosphate following a mitogenic stimulus). In addition, various methods are currently available for monitoring pathogen-specific responses, such as CMV-specific T-cell-mediated immune response, based on interferon-γ release assays, intracellular cytokine staining or main histocompatibility complex-tetramer technology. This review summarizes the clinical evidence to date supporting the use of these approaches to the post-transplant immune status, as well as their potential limitations. Intervention studies based on validated strategies for immune monitoring still need to be performed.

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“…The individual variations in MPA levels may be connected to the renal and liver function, body mass and genetic polymorphisms in the enzymes and other proteins responsible for drug metabolism and transport (16,17). Since 2008, TDM of MPA is not suggested as a routine test after renal transplantation (8,18,19). The considerable individual variance in blood level observed in this study underlines the fact that MPA level depends on several factors.…”

Section: Discussionmentioning

confidence: 84%

Monitoring of mycophenolic acid and kidney function during combined immunosuppressive therapy

Oláh¹,

Asztalos²,

Ivády³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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Background: Mycophenolic acid (MPA), a selective inhibitor of lymphocyte proliferation, has lately been used to improve renal function and prolong graft survival in renal transplanted patients. Still, there is no consensus considering the recommended dosing and the therapeutic range of MPA. Methods: To estimate the safe therapeutic range of MPA, its plasma level and indicators of kidney function were measured in 216 patients (138 male, 78 female, age 46"12 years) 67"46 months after transplantation. Besides MPA, patients received cyclosporine (Group A, ns122) or tacrolimus (Group B, ns77). Seventeen patients (Group C) were treated with MPA in combination with everolimus or sirolimus. Plasma MPA was measured by enzyme inhibition assay. Results: In the whole study group MPA level increased with the dose of MPA (ps0.013). MPA level was below the therapeutic range in 40% (Group A) and 45% (Group B) of patients, respectively. MPA was 1.9"1.56 mg/L in Group A, 2.4"1.69 mg/L in Group B. In Group A MPA level increased and cyclosporine decreased with the progress of renal disease. Conclusions: Increasing MPA/cyclosporine ratio at more severe stages of chronic kidney disease was tolerable for the patients and rejection could be avoided. Tubular damage detected by urinary N-acetyl-b-D-glucosaminidase did not correlate with the MPA level.

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Therapeutic Monitoring of Mycophenolate in Transplantation: Is It Justified?

Cited by 33 publications

References 75 publications

Short-Term Intensified Dosage Regimen of Mycophenolic Acid is Associated with Less Acute Rejection in Kidney Transplantation from Donation after Circulatory Death

Short-Term Intensified Dosage Regimen of Mycophenolic Acid is Associated with Less Acute Rejection in Kidney Transplantation from Donation after Circulatory Death

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

Monitoring of mycophenolic acid and kidney function during combined immunosuppressive therapy

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