engleski

Mycophenolic acid and cyclosporine in kidney transplantation. Is therapeutic drug monitoring important?

Introduction: Mycophenolate mofetil (MMF) is a prodrug of the immunosupressive agent, mycophenolic acid (MPA) used in prophylaxis of rejection of transplanted solid organs in combination with cyclosporine A (CyA) and steroids. Material and Methods: MPA was determined in 109 stable kidney transplant patients aged 11-60 years. All were receiving MMF in combination with CyA and low dose of steroids. The aim of study was to determine the concentrations of MPA, CyA and creatinine in patients with kidney graft and find out if there is correlation between standard daily MMF dose and MPA concentrations, a correlation between MPA and CyA concentration, a correlation between MPA concentrations and serum creatinine (surogat marker of kidney function), and a correlation between CyA level and creatinine. Results: After stabilisation of kidney function, more than 6 months posttransplant, mean doses of MMF and CyA were 880.0± 202.6 mg/m2 and 2, 5± 1, 29 mg/kg BW, respectively. MPA concentration was measured by HPLC method on the Chromsystems column with 1, 0 mL/min flow and UV detector (λ=215 nm). CyA concentration was determined using immunoassay method (Dimension, Dade Behring). Mean serum concentration (C-0) of MPA was 6.9± 4, 8 µmol/L, and mean CyA concentration (C-0) in whole blood was 135, 4± 47, 1 µmol/L. Mean creatinine value was 129.2±58.5 µmol/L. No correlation was observed between MMF daily dose (mg/m2 ) and MPA trough concentration in serum (µmol/L) (P< 0, 05). Also there was no correlation between MPA and CyA concentrations (P<0, 05) and CyA and creatinine (P<0, 05), so as between MPA and creatinine (P<0, 05). Conclusions: The absence of correlation between the stated parameters indicates the need to monitor therapeutic concentrations of MPA in order to optimize therapy, similarly to regular monitoring of CyA concentrations.

transplantation; mycophenolic acid

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