Is The Therapeutic Efficacy of Mycophenolate Mofetil In The Treatment Of Cardiac Allograft Rejection Related To Blood Level?

Abstract

74 Mycophenolate Mofetil (MMF) is a unique immunosupressive agent that has shown to be efficacious in the treatment of cardiac allograft rejection (REJ). Prior reports suggest that MMF efficacy in Tacrolimus based patients is related to MMF blood level. The objective of this study is to evaluate the incidence of REJ in relation to the blood level. Between November 1997 and October 1998, we retrospectively analyzed the clinical outcome of 133 MMF treated patients post cardiac transplant (TX) who had regular MMF blood level monitoring at the time of heart biopsy. Mean follow up period was 6.5 mos. Demographics were as follows: 82% male, mean age 51.2 yrs; 19% were on mechanical support. 94% of pts were on cyclosporine (CSA), 6% Tacrolimus; prednisone was initiated at 20 mg daily on all pts. Samples were divided into 3 groups, according to the 12 hr trough blood level (group I: <2, group II: 2-4, group III: >4 mg/l, see Table). REJ was defined as ISHLT grade 3A or greater. The mean blood level of the REJ and REJ free group was 2.37±1.86 and 2.44±1.86 mg/l (P=0.26). No significant renal, hematologic, or hepatic side effects were noted.Table: Therapeutic Efficacy of MMF in Relation to Blood Level Conclusions: MMF therapeutic efficacy as an immunosuppressive agent in the treatment of cardiac allograft REJ may be independent of its blood level. Further analysis in cardiac TX pts immunosupressed with CSA and prednisone is required. Monitoring blood level may not be cost-effective.