title: The effect of MMF dose and trough levels on adverse effects in pediatric heart transplant recipients.
abstract: Limited pharmacokinetic and safety data exist for MMF in pediatric HTR. Previously targeted MPA-TL are 1.5-3.0 μg/mL. The objective of this study was to assess the outcomes targeting MPA-TL of 0.8-2.0 μg/mL in pediatric HTR. MPA-TL were retrospectively collected 2-12 months post-transplant. Acute rejection, infection, leukopenia, and GI complaints were then correlated with MPA-TL. A total of 355 MPA-TL from 22 HTR were included. Median age was 2.5 yr. Primary indication for transplant was dilated cardiomyopathy (64%). Mean MPA-TL was 1.7 ± 0.9 μg/mL. African American patients received significantly higher doses (702 ± 235 mg/m(2) ) compared with other races (p = 0.035). Leukopenia was less common in patients with SUB MPA vs. others (p = 0.01). MMF was discontinued for GI complaints in one patient and leukopenia in two patients. One SUB patient had acute rejection, and one SUP patient had infection. One-yr survival was 100%. Targeting a lower range for MPA-TL was not associated with significant rejection or infection. Despite lower MPA-TL, MMF was discontinued in 3/22 patients for adverse effects.
authors.affiliation: Department of Pharmacy, Children's Hospital at Montefiore, Bronx, NY, USA.
authors.forename: Nida
authors.initials: N
authors.lastname: Siddiqi
authors.affiliation: Cardiology Division, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Lamour
authors.affiliation: Cardiology Division, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA.
authors.forename: Daphne T
authors.initials: DT
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: cardiac transplantation; mycophenolate mofetil; pediatric heart transplant; therapeutic drug monitoring