Pharmacokinetics of mycophenolate mofetil in Omani patients on cyclosporine or tacrolimus.

BACKGROUND: Mycophenolate mofetil (MMF) reduces rejection in organ transplantation and is effective in controlling autoimmune diseases. Determining the area under the receiver operating characteristic curve (AUC) of MMF is not routine despite interindividual variability. The aim of this study was to look into MMF-AUC in Omani patients on cyclosporine (CsA) or tacrolimus (Tac). METHODS: We measured MMF-AUC in 27 stable Omani patients. We used the 4-time-points-limited sampling strategy. RESULTS: Sixteen, 8, and 3 recipients were receiving Tac, CsA, and calcineurin inhibitor (CNI)-free regimens, respectively. The mean MMF dose was 1,685 ± 442 mg/d. All except 3 patients were within or above the target AUC. The AUC was significantly higher in patients receiving Tac versus CsA. All patients on Tac were within or above the target AUC. Seven of the 8 patients with MMF-AUC above target were receiving Tac. Two of the 3 patients with MMF-AUC below target were on CsA. DISCUSSION: These preliminary results confirm the significant interindividual variability of MMF-AUC. None of the recipients on Tac had an AUC below target. Most patients above the target AUC were receiving Tac. Two of the 3 patients with MMF-AUC below target were on CsA and receiving 1 g/d MMF. Patients on Tac are at risk of having higher than the target AUC, exposing them to overimmunosuppression. Recipients on CsA seem to require >1 g/d MMF. CONCLUSIONS: These preliminary results encourage measuring the AUC of MMF. The fixed MMF dose regimen seems to be unreliable to predict the AUC. Preventing under- or overimmunosuppression offsets the burden.

Attitude of the Omani population toward organ transplantation.

UNLABELLED: Transplantation from deceased donors is still scarce in Oman, mainly due to family refusal. We conducted a survey to learn the attitudes of the Omani population regarding transplantation. SUBJECTS AND METHODS: Among 500 individuals who were distributed, a questionnaire 304 responded including 247 (81%) Omani and 57 (19%) foreign residents. There were 213 (70%) male respondents of the 304 subjects, 256 individuals (84%) were between 18 and 50 years of age, and 270 (89%) had at least a high school education. RESULTS: Thirty-eight percent and 32% of Omani individuals had a family member or a friend with kidney disease or a renal transplantation, respectively. Only 42% of respondents knew that renal transplantation is performed in Oman. It was encouraging to note that 65% of Omanis knew that commercial transplantations are against Islamic and international standards. Sixty-four percent of the respondents stated that they would donate a kidney to a relative with renal failure. Nevertheless, only 49% knew that donation after death is permitted by Islam; 42% respondents would accept a kidney from a deceased person. Only 35% would donate a kidney or an organ after death. We concluded that the awareness of the Omani people toward donation after death is low, with a great need for public education and awareness programs, particularly for high school and university students.

Donor gender balance in a living-related kidney transplantation program in Oman.

It has been observed in several Eastern and Western countries that there is a gender imbalance among kidney donors. In the international experience, approximately 65% of live kidney donors have been women. We retrospectively studied the distribution of female and male donors or recipients among living kidney transplantations performed from 1980 to 2005, namely 198 Omani recipients of living-related kidney transplantations. To examine cultural influences, transplantations performed or expatriates were excluded from the study. For the whole period, 98 out of 198 donors (49.5%) were women. The number of female recipients 75 of 198 (38%) versus males were 123 (62%) recipients. We then subdivided the period into three intervals: 1980 to 1990, 1991 to 2000, and 2001 to 2005. The numbers of female donors for these three periods were 29 of 64 (45%), 42 of 89 (47%), and 27 of 45 (60%), respectively. There was a persistent preponderance of male recipients ranging from 58% to 66% during these periods. We concluded that there was no gender imbalance for kidney donors. Nevertheless, there was a male preponderance in the recipient group.