Mycophenolate mofetil absorption quotient: interest to clinical practice.
Use of mycophenolate mofetil (MMF) in kidney transplantation has led to significant improvements in the acute rejection index and graft survival. Posttransplant MMF levels are known to be of value for discriminating patients at risk of acute rejection. Trough MMF levels were measured in 153 patients who had undergone kidney transplantation more than 1 year before and showed stable graft function. MMF dosage was adjusted based on hematologic or gastrointestinal toxicity. The quotient between the weight-adjusted dose and through MMF levels was calculated in order to establish absorption type. We analyzed the diagnostic value of this quotient in relation to creatinine proteinuria, hematologic and gastrointestinal toxicity based upon percentiles of 10, 25, 50, 75, and 90, which were used as cutoff points. Mean MMF levels were 3.79 +/- 3.3 mg/L. Mean quotient value was 6.55 +/- 9.2. A significant correlation was found between MMF dosage and MMF trough levels (r = .34, P < .01). However, no correlation was seen between MMF dosage and the quotient. There were no significant differences in the analyzed parameters and the percentiles established as cutoff points. However, patients with gastrointestinal toxicity had a larger quotient (9.07 +/- 7.45.3 vs 5.28 +/- 4.9). The relationship between MMF dose and levels does not establish differences in kidney function and proteinuria among stable transplant patients; patients with diarrhea may show decreased absorption.
Fernández
A
A
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain. afernandezr.hrc@salud.madrid.org
Villafruela
J
J
Amezquita
Y
Y
Caldés
S
S
Marcen
R
R
Galeano
C
C
Pascual
J
J
Rodriguez-Mendiola
N
N
Ortuño
J
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D007408:Intestinal Absorption / Q000502:physiology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D015588:Observer Variation; D055815:Young Adult
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid