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World J Gastroenterol. Aug 21, 2014; 20(31): 10715-10728
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10715
Clinical mycophenolic acid monitoring in liver transplant recipients
Hao Chen, Bing Chen
Hao Chen, Center of Organ Transplantation and Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
Bing Chen, Institute of Clinical Pharmacology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: Chen H and Chen B performed and wrote the paper; Chen H designed and performed the review.
Correspondence to: Hao Chen, PhD, Center of Organ Transplantation and Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Erlu, Shanghai 200240, China. haochendr@126.com
Telephone: +86-21-64370045 Fax: +86-21-64333548
Received: September 17, 2013
Revised: June 3, 2014
Accepted: June 26, 2014
Published online: August 21, 2014
Abstract

In liver transplantation, the efficacy of mycophenolate mofetil (MMF) has been confirmed in clinical trials and studies. However, therapeutic drug monitoring for mycophenolic acid (MPA) has not been fully accepted in liver transplantation as no long-term prospective study of concentration controlled vs fixed-dose prescribing of MMF has been done. This review addressed MPA measurement, pharmacokinetic variability and reasons of this variation, exposure related to acute rejection and MMF-associated side effects in liver transplant recipients. Limited sampling strategies to predict MPA area under the concentration-time curve have also been described, and the value of clinical use needs to be investigated in future. The published data suggested that a fixed-dosage MMF regimen might not be suitable and monitoring of MPA exposure seems helpful in various clinical settings of liver transplantation.

Keywords: Mycophenolate mofetil, Mycophenolic acid, Pharmacokinetics, Therapeutic drug monitoring, Liver transplantation

Core tip: We discussed the methods of mycophenolic acid (MPA) monitoring, pharmacokinetic characteristics, clinical exposure related to acute rejection and mycophenolate mofetil (MMF) associated side effects in liver transplant recipients. We also introduced the methods of limited sampling strategies to predict the MPA area under the concentration-time curve. It demonstrated that a fixed-dosage MMF regimen might not be suitable. In clinical settings, monitoring of MPA exposure seems reasonable and necessary.