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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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Monitoring of mycophenolic acid and kidney function during combined immunosuppressive therapy

Anna V. Oláh1 / László Asztalos2 / Gergely Ivády1 / Éva Varga3 / Ágota M. Kovács1 / János Kappelmayer1 / József Varga4

1Department of Clinical Biochemistry and Molecular Pathology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

2Department of Surgery, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

3Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

4Department of Nuclear Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

Corresponding author: Anna V. Oláh, PhD, Department of Clinical Biochemistry and Molecular Pathology, Medical and Health Science Center, University of Debrecen, Nagyerdei krt. 98. 4032 Debrecen, Hungary Phone: +36-52-340 006, Fax: +36-52-417 631,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 11, Pages 1849–1853, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/cclm.2011.678, August 2011

Publication History

Received:
2011-01-13
Accepted:
2011-07-26
Published Online:
2011-08-18

Abstract

Background: Mycophenolic acid (MPA), a selective inhibitor of lymphocyte proliferation, has lately been used to improve renal function and prolong graft survival in renal transplanted patients. Still, there is no consensus considering the recommended dosing and the therapeutic range of MPA.

Methods: To estimate the safe therapeutic range of MPA, its plasma level and indicators of kidney function were measured in 216 patients (138 male, 78 female, age 46±12 years) 67±46 months after transplantation. Besides MPA, patients received cyclosporine (Group A, n=122) or tacrolimus (Group B, n=77). Seventeen patients (Group C) were treated with MPA in combination with everolimus or sirolimus. Plasma MPA was measured by enzyme inhibition assay.

Results: In the whole study group MPA level increased with the dose of MPA (p=0.013). MPA level was below the therapeutic range in 40% (Group A) and 45% (Group B) of patients, respectively. MPA was 1.9±1.56 mg/L in Group A, 2.4±1.69 mg/L in Group B. In Group A MPA level increased and cyclosporine decreased with the progress of renal disease.

Conclusions: Increasing MPA/cyclosporine ratio at more severe stages of chronic kidney disease was tolerable for the patients and rejection could be avoided. Tubular damage detected by urinary N-acetyl-β-D-glucosaminidase did not correlate with the MPA level.

Keywords: cyclosporine; estimated glomerular filtration rate (eGFR); kidney transplantation; mycophenolic acid; N-acetyl-β-D-glucosaminidase; therapeutic range

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