J Korean Soc Transplant.  2009 Sep;23(2):135-140. 10.4285/jkstn.2009.23.2.135.

Decision Factors on Mycophenolic Acid Dose after Renal Transplantation

• Kim SJ
• Kim MS
• Han DJ
• Yang CW
• Lee S
• Yun IJ
• Cho BS
• Lee TW
• Rim H
• Kim MJ
• Han DC
• Shin GT
• Oh CK
• Do JY
• Han SY
• Choi SJ
• Na KR

• KMID: 2097080
• DOI: http://doi.org/10.4285/jkstn.2009.23.2.135

Abstract

BACKGROUND
Triple immunosuppressant therapy including anti-metabolites is the representative immunosuppressive therapy after renal transplantation. This study is to evaluate the factors that influence Mycophenolate sodium (MPS, Myfortic, Novartis, Basel, Switzerland) dosage patterns in renal transplantation patients who take MPS as an inosine monophosphate dehydrogenase (IMPDH) among antimetabolites.
METHODS
From May 2007 to April 2008, 16 clinical departments of 14 transplantation centers in Korea retrospectively performed a survey on 650 renal transplantation recipients taking MPS. This survey collected personal information, clinical factors related to transplantation and immunosuppressive therapy.
RESULTS
The mean age of the patients was 43.0+/-12.0 (7~75) and the study included 364 males (56.0%) and 286 females (44.0%). The average follow up period after renal transplantation was 49.5+/-53.4 (1~307) months. There were 366 (56.3%) living related cases, 145 (22.3%) living non-related cases and 139 (21.4%) deceased donor cases. Cyclosporine was the most common calcineurin inhibitor (CNI) used in combination therapy with MPS (476 cases, 73.2%) followed by tacrolimus (169 cases, 26.0%). The mean daily dose of MPS was 909.7+/-336.3 (180~1,620)mg and the mean daily dose per kg was 15.3+/-5.9 (2.65~32.73)mg/kg. The daily dose showed significant positive correlation with patient body weight but the daily dose per kg showed negative correlation. The daily dose of MPS was significantly higher in the combination therapy with cyclosporine than that with tacrolimus. The daily dose and the dose per kg decreased with increment of recipient age and post-transplant period.
CONCLUSIONS
Our study concluded that MPS dosages correlated with the combined type of CNI, post-transplant period and age.

Keyword

Mycophenolate sodium; Kidney transplantation; Dose

MeSH Terms

Body Weight
Calcineurin
Cyclosporine
Female
Follow-Up Studies
Humans
Inosine Monophosphate
Kidney Transplantation
Korea
Male
Mycophenolic Acid
Oxidoreductases
Retrospective Studies
Sodium
Tacrolimus
Tissue Donors
Transplants
Calcineurin
Cyclosporine
Inosine Monophosphate
Mycophenolic Acid
Oxidoreductases
Sodium
Tacrolimus

Figure

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  Fig. 1. Correlation of mycophenolate sodium (MPS) dose and recipient body weight. The daily dose of MPS positively correlated with weight (Y=468.1+7.304∗X, P＜0.0001, R2=0.053) (A), but the daily dose per weight negatively correlated with weight (Y=23.653−0.138∗X, P＜0.0001, R2=0.061) (B).

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  Fig. 2. Correlation of mycophenolate sodium (MPS) dose with combined immunosuppressants. MPS dose positively correlated with cyclosporine dose (P＜0.0001) (A), but MPS dose showed no correlation with tacrolimus dose (P=0.668, P=0.481) (B).

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  Fig. 3. Distribution of mycophenolate sodium (MPS) dose by recipient age (P＜0.0001 by ANOVA test).

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  Fig. 4. Correlation of mycophenolate sodium (MPS) dose and posttransplant period. Dose of MPS negatively correlated with posttransplant period (Y=986.291−1.583∗X, P＜0.0001, R2=0.063).

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