Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation
Clinical and Molecular Hepatology
;
: 291-299, 2014.
Article
in English
| WPRIM
| ID: wpr-106796
ABSTRACT
BACKGROUND/AIMS:
The dose of mycophenolate mofetil (MMF) has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT).METHODS:
Two sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12) for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day) with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter), with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT.RESULTS:
In the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day), and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively.CONCLUSIONS:
A reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Tissue Donors
/
Retrospective Studies
/
ROC Curve
/
Follow-Up Studies
/
Liver Transplantation
/
Tacrolimus
/
Liver Failure
/
Area Under Curve
/
Drug Therapy, Combination
/
Gastrointestinal Diseases
Type of study:
Practice guideline
/
Observational study
/
Prognostic study
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
Language:
English
Journal:
Clinical and Molecular Hepatology
Year:
2014
Type:
Article
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