title: Levels of mycophenolic acid and its glucuronide derivative in the plasma of liver, small bowel and kidney transplant patients receiving tacrolimus and cellcept combination therapy.
abstract: In order to help assess the usefulness of mycophenolate mofetil (MMF) as an immunosuppressive agent in recipients of organs other than kidneys, we measured the trough levels of the active metabolite of MMF, mycophenolic acid (MPA), and its inactive glucuronide derivative (MPAG), in the plasma of liver (n = 83) and small bowel transplant patients (n = 15) receiving MMF in combination with tacrolimus. These levels were compared with a group of renal transplant patients (n = 25) receiving the same drug regimen. All patient groups were otherwise comparable except the small bowel patient group which contained more pediatric patients (average age 18.7 +/- 3.9 years), and, therefore, received a higher average drug dose (in mg/kg). Despite this, these patients displayed the lowest levels of MPA of any group (0.39 +/- 0.08 microg/ml, P < 0.001 vs. 1.10 +/- 0.17 microg/ml for liver transplant patients, P < 0.001 or 2.46 +/- 0.37 microg/ml for renal transplant patients, P < 0.001). There were no statistically significant differences in MPAG levels between any of the groups. Although preliminary, these data demonstrate significant transplanted organ-specific differences in MMF pharmacology and/or bioavailability, and suggest the need for separate evaluation of MMF dosing for each transplant type.
authors.affiliation: Department of Surgery, University of Miami School of Medicine, FL, USA. tsihrin@otenet.gr
authors.forename: A K
authors.initials: AK
authors.lastname: Tsaroucha
authors.forename: K
authors.initials: K
authors.lastname: Zucker
authors.forename: V
authors.initials: V
authors.lastname: Esquenazi
authors.forename: L
authors.initials: L
authors.lastname: de Faria
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D020719:Glucuronides / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007421:Intestine, Small / Q000637:transplantation*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood* / Q000378:metabolism; D016559:Tacrolimus / Q000008:administration & dosage* / Q000378:metabolism
chemical_list: D020719:Glucuronides; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus