title: Short-term therapeutic drug monitoring of mycophenolic acid reduces infection: a prospective, single-center cohort study in Chinese living-related kidney transplantation.
abstract: BACKGROUND
  The role of therapeutic drug monitoring (TDM) of mycophenolic acid (MPA) in kidney transplant recipients (KTRs) is not clear. We performed a prospective cohort study to evaluate the efficiency of MPA TDM in the Chinese population.
  
  
  METHODS
  A total of 183 living-related KTRs were studied; 101 KTRs received controlled-dose mycophenolate mofetil (MMF) (the CD group), and 82 patients received fixed-dose MMF (the FD group). MPA exposure was measured at days 3, 7, 14, and 30 in the CD group, and at day 30 in the FD group. The primary endpoint was treatment failure (a composite of acute rejection, graft loss, death, or MMF discontinuation) at 12 months post transplantation.
  
  
  RESULTS
  In the CD group, with a starting MMF dose of 2 g/day, approximately 35% of patients had high MPA levels, which were >60 mg × h/L, and mean MPA levels were 59.17 mg × h/L and 61.38 mg × h/L for the CD and FD groups, respectively (P = 0.588). After adjusting MMF dose, MPA exposures in the CD group at day 30 were lower than those in the FD group at day 30 (54.06 vs. 61.38, P = 0.004). At month 12, the CD group had fewer infections (16.8% vs. 31.7%, P = 0.018) with no difference in treatment failure, acute rejection, diarrhea, or anemia.
  
  
  CONCLUSIONS
  KTRs can benefit from short-term TDM of MPA in reducing infection, without increasing acute rejection.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Sichuan, People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Fu
authors.forename: Z
authors.initials: Z
authors.lastname: Huang
authors.forename: T
authors.initials: T
authors.lastname: Song
authors.forename: S
authors.initials: S
authors.lastname: He
authors.forename: D
authors.initials: D
authors.lastname: Zeng
authors.forename: Z
authors.initials: Z
authors.lastname: Rao
authors.forename: L
authors.initials: L
authors.lastname: Xie
authors.forename: Y
authors.initials: Y
authors.lastname: Song
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: T
authors.initials: T
authors.lastname: Lin
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001424:Bacterial Infections / Q000517:prevention & control; D002681:China; D016903:Drug Monitoring; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016030:Kidney Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood* / Q000493:pharmacokinetics; D009181:Mycoses / Q000517:prevention & control; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: area-under-curve; infection; kidney transplant; mycophenolate mofetil; renal transplantation; therapeutic drug monitoring