SAT-333 MYCOPHENOLIC ACID MONTTORNIC IN RENAL ALIOGRAFT RECIPIENTS; ASSOCIATATION WITH SAFETY AND EFFICACY

Abstract

Mycophenolic acid (MPA) is one of the cornerstones immunosuppressants in the setting of transplantation. Advances in the pharmacokinetic studies have uncovered the high inter and intra_individual variability of plasma mycophenolic acid level. This variability in drug concentration can cause both supra therapeutic and sub therapeutic drug plasma levels which can have hazardous results in transplant patients. To date, routine therapeutic drug monitoring of MPA has not been established in clinical practice. Aim of the work: Our objective was to monitor the level of MPA in relation to the occurrence of gastrointestinal (GI) complications and renal function in renal allograft recipients. MPA trough level was measured in 51 renal allograft recipients at the entry of the study and 4 weeks after any dose modification. Levels were correlated with the side effects recorded during the study follow up period. GI toxicity, hematological toxicity and biopsy proven acute rejection (BPAR) were diagnosed in 29.4%, 9.8% and 11.7% of the studied population respectively. Higher MPA 12-hr trough levels were associated with hematological side effects, yet, the correlation with GI side effects was largely negative. A significant correlation between low MPA plasma levels and the development of BPAR after kidney transplantation was detected. An MPA level of 3.5 µg/mL best discriminated between patients who developed hematological toxicity from those who didn’t while MPA level of 2.4 µg/mL best discriminated between patients with and without BPAR. Monitoring of MPA trough level should be practiced in renal allograft recipients in order to avoid drug toxicity without compromising efficacy.