J Korean Soc Transplant.  2018 Dec;32(4):75-83. 10.4285/jkstn.2018.32.4.75.

Monitoring of Mycophenolic Acid Trough Concentration in Kidney Transplant under Cyclosporine Is Beneficial in Reducing Acute Rejection within 1 Year

• Rhu J
• Lee KW
• Park JB
• Kim SJ

• KMID: 2430587
• DOI: http://doi.org/10.4285/jkstn.2018.32.4.75

Abstract

BACKGROUND
This study was designed to analyze the clinical usefulness of mycophenolic acid trough concentration monitoring in kidney transplantation patients who were maintained with cyclosporine.
METHODS
The data of patients who underwent mycophenolic acid trough concentration monitoring after their first kidney transplant between November 2006 and August 2013 and were prescribed with cyclosporine, mycophenolate, and methylprednisolone were reviewed retrospectively. Cox analysis was used to analyze the risk factors for acute rejection within 1 year post-transplantation.
RESULTS
Among 90 patients, 41 (45.6%) achieved both the target levels of cyclosporine and mycophenolic acid, while three patients (3.3%) failed to achieve the target level of either cyclosporine or mycophenolic acid. Nine patients (10.0%) only achieved the mycophenolic acid target level and 37 patients (41.1%) only achieved the cyclosporine target level. While patients who achieved only the mycophenolic acid target concentration had no statistically increased risk compared to patients who achieved both target levels (hazard ratio [HR], 1.569; 95% confidence interval [CI], 0.316 to 7.778; P=0.581), patients who only achieved the cyclosporine target concentration showed an increased risk of rejection compared to the both achievement group (HR, 4.112; 95% CI, 1.583 to 10.683; P=0.004). Patients who had no achievement in the target levels showed significantly increased rejection risk compared to the patients who achieved both target levels (HR, 17.811; 95% CI, 3.072 to 103.28; P=0.001).
CONCLUSIONS
Mycophenolic acid trough concentration monitoring combined with cyclosporine trough concentration monitoring is useful for avoiding acute cellular rejection if the first 1 year post-transplantation.

Keyword

Kidney transplantation; Mycophenolic acid; Drug monitoring

MeSH Terms

Cyclosporine*
Drug Monitoring
Humans
Kidney Transplantation
Kidney*
Methylprednisolone
Mycophenolic Acid*
Retrospective Studies
Risk Factors
Cyclosporine
Methylprednisolone
Mycophenolic Acid

Figure

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  Fig. 1 Biopsy-proven acute rejection-free survival curves of patients categorized by three groups: Patients who achieved both target levels of cyclosporine A (CsA) and mycophenolic acid (MPA) (n=41), patients who only achieved one target level (n=46), and patients who failed to achieve neither of the target levels (n=3). The hazard ratios (HRs) of the latter two subgroups were calculated comparing to the biopsy-proven acute rejection-free survival of the first subgroup. Abbreviation: CI, confidence interval.

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