Achieving Timely Therapeutic Mycophenolic Acid Levels in Pediatric Lung Transplant Patients.
Texas Children's Hospital, Houston, TX.
Meeting: 2016 American Transplant Congress
Abstract number: B286
Keywords: Dosage, Immunosuppression, Lung transplantation, Mycophenolate mofetil
Session Information
Date: Sunday, June 12, 2016
Session Name: Poster Session B: Lung Transplantation Posters
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
The purpose of this study was to determine the appropriate initial dose of mycophenolate mofetil (MMF) in pediatric cystic fibrosis (CF) and non-CF lung transplant recipients to achieve a therapeutic mycophenolic acid (MPA) level within 14 days post-transplant.
Methods: At the authors' institution, non-CF patients are initiated on MMF 600mg/m2 every 12 hours, and CF patients are initiated on MMF 800mg/m2 every 12 hours, and are titrated to an MPA trough of 1–3.5mcg/mL. A retrospective chart review was conducted on lung transplant recipients from January 1, 2013 through October 31, 2014. Patients were categorized as “Per Protocol” if the initial MMF dose was within ±100mg/m2 of the aforementioned doses. The time from transplantation to the first therapeutic MPA level was calculated, and the MMF dose in mg/m2 was documented.
Results: During the study period, 31 patients were transplanted. Table 1 summarizes the demographics and results for CF and non-CF patients.
|
Table 1 |
CF |
Non-CF |
||||
|
|
Total |
Per Protocol |
Not Per Protocol |
Total |
Per Protocol |
Not Per Protocol |
|
n (%) |
11 (100) |
7 (64) |
4 (36) |
20 (100) |
11 (55) |
9 (45) |
|
Male (%) |
6 (54) |
– |
– |
6 (30) |
– |
– |
|
Avg Age at Transplant (yr) |
12.8 |
– |
– |
8.3 |
– |
– |
|
Avg Dose to Achieve 1st Therapeutic Level (mg/m2) |
961 |
966 |
952 |
783 |
739 |
837 |
|
Avg Time in Days to Achieve 1st Therapeutic Level (range) |
14.9 |
19 (10-28) |
7.75 (4-11) |
16.2 |
16.7 (4-41) |
15.5 (4-30) |
|
Number of Patients Therapeutic by 2 Weeks Post-Transplant (%) |
7 (64%) |
3 (43%) |
4 (100%) |
9 (45%) |
5 (45%) |
4 (44%) |
Among CF patients, 71% of patients dosed per protocol required dose increases, compared to 0% among those who were not. Among non-CF patients, 45% of patients dosed per protocol required dose increases, compared to 33% among those who were not. Based on these results, in January 2015, the initial MMF dosing recommendation was increased by 100mg/m2 for both CF and non-CF lung transplant recipients. Since then, four CF patients and three non-CF patients have been transplanted. Six patients (86%) achieved a first therapeutic MPA level without dose adjustments. The average time to a therapeutic MPA level was six days.
Conclusions: In order to attain a therapeutic MPA level within 14 days post-lung transplant, non-CF patients may require an initial MMF dose of 700 mg/m2 every 12 hours, and CF patients may require an initial MMF dose of 900 mg/m2 every 12 hours.
CITATION INFORMATION: Kam C, Kim S, Melicoff E. Achieving Timely Therapeutic Mycophenolic Acid Levels in Pediatric Lung Transplant Patients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Kam C, Kim S, Melicoff E. Achieving Timely Therapeutic Mycophenolic Acid Levels in Pediatric Lung Transplant Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/achieving-timely-therapeutic-mycophenolic-acid-levels-in-pediatric-lung-transplant-patients/. Accessed February 27, 2021.« Back to 2016 American Transplant Congress