A clinical assessment of mycophenolate drug monitoring after liver transplantation

Shin Hwang, Sung Gyu Lee, Chul Soo Ahn, Ki Hun Kim, Deok Bog Moon, Tae Yong Ha, Gi Won Song, Dong Hwan Jung, Nam Kyu Choi, Kwan Woo Kim, Young Dong Yu, Gil Chun Park, Pyoung Jae Park, Young Il Choi

    Research output: Contribution to journalArticlepeer-review

    16 Citations (Scopus)


    Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF). Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it. Methods: A series of short-term prospective studies on TDM for MPA and/or tacrolimus was performed at a large-volume center. Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus-MMF therapy (n = 270), MMF-minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus-MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF-minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p < 0.001), in which r2 was fluctuating from 0.056 to 0.213 according to the post-transplant period over five yr; wide intraindividual variation was also observed during the first two months (n = 12, r2 < 0.2, p > 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF-minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%. Conclusion: MPA TDM-based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation.

    Original languageEnglish
    Pages (from-to)E35-E42
    JournalClinical Transplantation
    Issue number2
    Publication statusPublished - 2010 Mar


    • Immunosuppression
    • Liver transplantation
    • Mycophenolate mofetil
    • Mycophenolic acid
    • Therapeutic drug monitoring

    ASJC Scopus subject areas

    • Transplantation


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