Mycophenolic Acid Area-Under-Curve (MPA AUC) Levels Sufficient to Prevent Donor-Specific Antibody (DSA) Formation Are Not Associated With Higher Rates of CMV/EBV/BK Viral Infections
PinnacleHealth, Harrisburg, PA.
Meeting: 2015 American Transplant Congress
Abstract number: A122
Keywords: Antibodies, Area-under-curve (AUC), Infection
Session Information
Date: Saturday, May 2, 2015
Session Name: Poster Session A: Kidney Antibody Mediated Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Prevention of DSA formation and antibody-mediated rejection mandates therapeutic doses of immunosuppressive agents, including MPA. We have shown that MPA AUC monitoring and dose adjustment (MPA AUC >60) minimizes and can reverse DSA formation. The purpose of this study was to determine if CMV/EBV/BK virus infection rates are associated with higher MPA AUC levels. Methods: This is a retrospective analysis of 211 patients who underwent renal transplantation from January 2011-June 2014. All patients were assessed for viral infections. MPA AUC testing was performed on 159 patients: 121 patients were infection-free; 38 were diagnosed with CMV/EBV/BK viral infection (+PCR or tissue invasive disease). These patients were assessed for age, MPA AUC, MPA dose, immune cell function(ICF), induction with thymoglobulin, serologic status, Cytogam prophylaxis, and acute rejection. Student's t-test was used to determine statistical differences between infected and non-infected groups. Results: Of the 211 patients surveyed, infection rates were CMV 9.0%, EBV 3.3%, BK-serum 11.4%, BK-urine 4.2%. Comparisons of MPA AUC-tested patient groups are summarized below(expressed as mean + SEM):
| n | Age(range) | MPA AUC (mg h/L) | MMF Dose(mg/day) | Thymoglobulin dosage (g) | ICF | |
| Non-Infected | 121 | 52.3(19-84) | 79.3±2.2 | 1992±47 | 3.48±0.23 | 256±13 |
| All Infected | 38 | 52.4(20-75) | 76.0±3.5 | 1987±91 | 4.77±0.40* | 231±19 |
| CMV | 14 | 51.9(38-68) | 65.0±4.3 | 1929±181 | 5.33±0.77* | 229±33 |
| EBV | 3 | 49.3(35-59) | 72.4±17 | 1500±289 | 5.34±0.54 | — |
| BK-serum | 18 | 53.9(34-74) | 74.3±4.3 | 2083±129 | 4.73±0.69* | 260±27 |
| BK-urine | 7 | 48.9(20-75) | 86.9±13 | 1786±149 | 4.26±0.84 | 189±56 |
| *p<0.05 |
Demographic data was similar between all groups. No statistically significant differences in age, MPA AUC, MPA dose or ICF were observed in infected patients vs non-infected patients. Induction thymoglobulin doses were significantly higher in infected patients, particularly in CMV and BK-serum patients, vs.non-infected patients.CMV mismatch rate was higher among CMV-infected (36%) vs non-infected patients (19%), despite higher rate of Cytogam prophylaxis (30% vs 17% respectively). Incidence of acute rejection was slightly higher in infected (23.7%) vs non-infected patients (18.4%). Conclusion: Optimal MPA administration, guided by MPA AUC (>60), is critical for prevention of DSA formation and renal dysfunction, and does not increase risk of CMV/EBV/BK viral infections in renal transplant recipients.
To cite this abstract in AMA style:
Narins S, Ladie D, Saylor R, Richards E, Yang H, Waybill M. Mycophenolic Acid Area-Under-Curve (MPA AUC) Levels Sufficient to Prevent Donor-Specific Antibody (DSA) Formation Are Not Associated With Higher Rates of CMV/EBV/BK Viral Infections [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/mycophenolic-acid-area-under-curve-mpa-auc-levels-sufficient-to-prevent-donor-specific-antibody-dsa-formation-are-not-associated-with-higher-rates-of-cmvebvbk-viral-infections/. Accessed September 30, 2020.« Back to 2015 American Transplant Congress