title: Pharmacokinetics of mycophenolate mofetil in kidney transplant patients with renal insufficiency.
abstract: Mycophenolate mofetil (MMF) is an immunosuppressant that is widely used for prophylaxis of rejection in solid organ transplantation. In this study, we examined the effect of renal insufficiency on the pharmacokinetics of MMF, particularly on the free fraction of drug in renal transplant patients. Our study was performed on 10 patients with severe renal insufficiency (creatinine clearance [CrCl] <30 mL/min), and 10 control patients with preserved renal function (CrCl >90 mL/min). All the patients had received a cadaveric donor graft at least 1 year prior and were clinically stable under treatment with MMF and cyclosporine. For each patient, we determined 12-hour areas under the curve (AUC(0-12 h)) for the metabolites: mycophenolic acid (MPA), 7-O-mycophenolic acid glucuronide (MPAG), and the free non-protein-bound fraction of MPA (f-MPA). The two groups were matched for age, sex, and MMF dose. Mean AUC(0-12 h) values for MPA were similar in both groups. The renal insufficiency group showed a significantly increased AUC(0-12 h) for MPAG (1550 +/- 392 vs 3527 +/- 1130 microg.h/mL, P < .001) and increased trough and AUC(0-12 h) values for f-MPA (0.023 +/- 0.02 vs 0.094 +/- 0.07 microg/mL, P = .003, and 0.87 +/- 0.3 vs 1.52 +/- 0.8 microg . h/mL, P = .016, respectively). We proposed that these differences should be taken into account when deciding upon the dose of this drug for the subset of patients with impaired transplant function.
authors.affiliation: Servicio de Nefrología, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain. fmgonzalezr@senefro.org
authors.forename: F M
authors.initials: FM
authors.lastname: González-Roncero
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.forename: M
authors.initials: M
authors.lastname: Brunet
authors.forename: G
authors.initials: G
authors.lastname: Algarra
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.forename: V
authors.initials: V
authors.lastname: Cabello
authors.forename: M
authors.initials: M
authors.lastname: Peralvo
mesh_terms: D019540:Area Under Curve; D001711:Biotransformation; D002102:Cadaver; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid