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논문분류	춘계학술대회 초록집
제목	Association of Mycophenolic Acid Trough Level with Adverse Events in Kidney Transplant Recipients
저자	Su Kyung Lee* 1, Kyu Yeun Kim1, Minjung Kim1, Wonseok Do1, Youngae Yang1, Taehoon Yim1, Inryang Hwang1, Hee-Yeon Jung1, Ji-Young Choi1, Jang-Hee Cho1, Sun-Hee Park1, Yong-Lim Kim1, Hyung-Kee Kim2, Seung Huh2, Dong-Il Won3, Chan-Duck Kim1
출판정보	2016; 2016(1):
키워드	Kidney Transplantation, mycophenolic acid, toxicity, trough level
초록	Background: Mycophenolic acid (MPA) is a widely used immunosuppressant to prevent acute rejection in kidney transplant recipients (KTRs). However, therapeutic drug monitoring of MPA for predicting its toxicity have shown inconsistent efficacy. We investigated the correlation of MPA trough concentration (MPA C0) with adverse events and transplant outcomes after kidney transplantation (KT). Methods: This study included 82 patients who underwent KT. All KTRs received MPA with tacrolimus and steroid. MPA C0 was determined monthly by using particle-enhanced turbidimetric inhibition immunoassay and clinical data were collected at each time point. Correlations between MPA dose and MPA C0 were analyzed with Pearson’s correlation. Clinical endpoints were biopsy-proven acute rejection (BPAR), leukopenia, anemia, thrombocytopenia, persistent diarrhea, and viral infection. To determine the effect of MPA C0 on the clinical endpoints, we performed logistic regression analysis. Results: MPA C0 was not correlated with MPA dose during the study period (r=0.112, p=0.354). MPA C0 was significantly higher in patients with leukopenia, anemia, thrombocytopenia and viral infection compared to patients without adverse events. (3.83±1.41 mg/L vs. 2.69±1.03 mg/L, p<0.001; 4.43±1.28 mg/L vs. 2.76±0.95 mg/L, p<0.001; 3.70±1.21 mg/L vs. 2.83±1.07 mg/L, p=0.002; 4.64±2.26 mg/L vs. 2.80±0.96 mg/L, p=0.017). Multiple logistic regression analysis revealed MPA C0 was independent risk factor for each of the above adverse events. (odds ratio [OR] 2.28, 95% CI 1.44-3.59, p<0.001; OR 4.04, 95% CI 1.88-8.70, p<0.001; OR 2.22, 95% CI 1.29-3.81, p=0.004; OR 2.21, 95% CI 1.15-4.26, p=0.018). Receiver operated characteristic analysis showed that MPA C0 of 3.54 mg/L, 3.79 mg/L, 3.53 mg/L and 4.27 mg/L were best predicted leukopenia, anemia, thrombocytopenia and viral infection, respectively. There was no association between MPA C0 with BPAR in the observation periods. Conclusion: MPA dose was not correlated with MPA C0 in KTRs. High MPA C0 increased the risk of leukopenia, anemia, thrombocytopenia and viral infection. Therefore, monitoring therapeutic trough level of MPA could be recommended to reduce MPA-related toxicity after KT.
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