Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor Kidney Transplantation.

Chen-guang Ding; Li-zi Jiao; Feng Han; He-li Xiang; Pu-xun Tian; Xiao-ming Ding; Xiao-ming Pan; Xiao-hui Tian; Yang LI; Jin Zheng; Wu-jun Xue

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Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor Kidney Transplantation.

Author: Chen-Guang DING ^{1
,

2} ; Li-Zi JIAO ^{1
,

2} ; Feng HAN ^{1
,

2} ; He-Li XIANG ^{1
,

2} ; Pu-Xun TIAN ^{1
,

2} ; Xiao-Ming DING ^{1
,

2} ; Xiao-Ming PAN ^{1
,

2} ; Xiao-Hui TIAN ^{1
,

2} ; Yang LI ^{1
,

2} ; Jin ZHENG ^{1
,

2} ; Wu-Jun XUE ^{1
,

2}
Author Information

1. Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University
2. Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Publication Type:Journal Article
Keywords: Acute Rejection; Enteric-Coated-Mycophenolate Sodium; Expanded Criteria Donor; Kidney Transplantation; Tacrolimus
MeSH: Adult; Female; Graft Rejection; immunology; prevention & control; Humans; Immunosuppressive Agents; chemistry; therapeutic use; Kidney Transplantation; adverse effects; methods; Male; Middle Aged; Mycophenolic Acid; chemistry; therapeutic use; Retrospective Studies; Tacrolimus; chemistry; therapeutic use; Time Factors
From: Chinese Medical Journal 2018;131(11):1302-1307
CountryChina
Language:English
Abstract:
BackgroundImmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection (BPAR) after expanded criteria donor (ECD) kidney transplantation. The aim of this study was to investigate the relationships between early immunosuppressive exposure and the development of BPAR.
MethodsWe performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolimus (Tac), and prednisone. The levels of mycophenolic acid-area under the curve (MPA-AUC) and Tac Cwere measured at the 1 week and the 1 month posttransplant, respectively. The correlation was assessed by multivariate logistic regression.
ResultsThe occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC at the 1 week posttransplant was found in BPAR recipients (38.42 ± 8.37 vs. 50.64 ± 13.22, P < 0.01). In addition, the incidence of BPAR was significantly high (P < 0.05) when the MPA-AUClevel was <30 mg·h·L at the 1 week (15.0% vs. 44.4%) or the Tac Cwas <4 ng/ml at the 1 month posttransplant (33.3% vs. 21.6%). Multivariable logistic regression analysis showed that the MPA-AUC at the 1 week (OR: 0.842, 95% CI: 0.784-0.903) and the Tac Cat the 1 month (OR: 0.904, 95% CI: 0.822-0.986) had significant inverse correlation with BPAR (P < 0.05).
ConclusionsLow-level exposure of MPA and Tac Cin the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC <30 mg·h·L and Tac C <4 ng/ml should be avoided in the first few weeks after transplantation.