title: Mycophenolate monitoring in liver, thoracic, pancreas, and small bowel transplantation: a consensus report.
abstract: Assessing the value of mycophenolic acid (MPA) monitoring outside renal transplantation is hindered by the absence of any trial comparing fixed-dose and concentration-controlled therapy. However, in liver and thoracic transplantation particularly, clinical trials, observational studies with comparison groups, and case series have described MPA efficacy, exposure/efficacy relationships, pharmacokinetic variability, and clinical outcomes relating to plasma MPA concentrations. On the basis of this evidence, this report identifies MPA as an immunosuppressant for which the combination of variable disposition, efficacy, and adverse effects contributes to interindividual differences seemingly in excess of those optimal for a fixed-dosage mycophenolate regimen. Combined with experiences of MPA monitoring in other transplant indications, the data have been rationalized to define circumstances in which measurement of MPA concentrations can contribute to improved management of mycophenolate therapy in nonrenal transplant recipients.
authors: Multi-Organ Transplant Program, McGill University Health Center, 687 Pine Avenue West (R2.58), Montreal, Quebec, Canada.
authors: Marcelo
authors: M
authors: Cantarovich
authors: Nigel W
authors: NW
authors: Brown
authors: Mary H H
authors: MH
authors: Ensom
authors: Ashok
authors: A
authors: Jain
authors: Dirk R J
authors: DR
authors: Kuypers
authors: Teun
authors: T
authors: Van Gelder
authors: J Michael
authors: JM
authors: Tredger
mesh_terms: D016903:Drug Monitoring / Q000379:methods*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007421:Intestine, Small / Q000637:transplantation; D016031:Liver Transplantation; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016035:Pancreas Transplantation
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid