MPA TDM Is Beneficial For Reducing The Dosage Of Corticosteroid In Renal Allograft Recipients

Objective To evaluate the efficacy and safety in renal allograftrecipients reducing the dosage of corticosteroids under the rational use ofMMF after MPA therapeutic drug monitoring(MPA TDM).Methods80kidney transplant recipients in our hospital whounderwent CsA+MMF+Pred triple immunosuppressive therapy werefollowed up. They were randomly divided into two groups:1) CsA+concentration-controlled MMF+half-dose Pred group (MPATDM group),2) CsA+fix-dose MMF+conventional-dose Pred group (Control group).For patients in MPA TDM group, the values of MPA-AUC0-12hwerecalculated by the simplified formula using limited sampling strategy. Andthe dosage of MMF was adjusted to reach the target range ofMPA-AUC0-12has30-60mg.h/L; the dosage of corticosteroid was reducedby at least50%. In Control group, relatively fixed dosage of MMF wasused without reduction in the dosage of corticosteroids.A12months’follow-up was conducted in all of the patients, compared with theincidence of clinical adverse events such as graft rejection, all kinds ofinfections, gastrointestinal disorders, hematopoietic system restrain in thepatients of two groups; and the difference of fasting blood glucose, bloodlipids, average blood pressure levels, immunosuppressants andaccompanying medications between two groups. Results For patients in MPA TDM group and Control group,prednisone dosage were (2.77±0.79) mg/d, and (6.00±1.77) mg/drespectively, the difference was statistically significant (p<0.05). Thedosage of CsA were (139.19±33.09）mg/d, and (147.50±31.42) mg/drespectively; the dosage of MMF were (1.51±0.32) g/d, and (1.42±0.30)g/d respectively; the differences between two groups were not statisticallysignificant (p>0.05). Patients with acute rejection rates in two groupswere7.5%and5.0%, there was no significant difference between groups.For patients in MPA TDM group and Control group, the incidence rate ofgastrointestinal disorder were17.5%and12.5%respectively; the incidencerate of infectious events were20%and22.5%respectively; the incidencerate of hematopoietic system restrain were both20%; all the differencesbetween two groups were not statistically significant (p<0.05). Fastingplasma glucose levels were (5.36±0.50) mmol/L in MPA TDM group, and(5.78±1.19) mmol/L in Control group, the difference was statisticallysignificant (p<0.05); triglycerides levels were (1.49±0.32) mmol/L、(1.56±0.60) mmol/L in two groups; total cholesterol levels were (5.13±0.92) mmol/L、(5.16±0.92) mmol/L in two groups; the average bloodpressure levels were (127.24±7.70/73.54±6.44) mmHg、(130.18±8.73/74.70±5.93) mmHg; all the differences between groups were notstatistically significant (p>0.05). There was no statistically significantdifference among the patients with application of diabetes and bloodpressure drugs and lipid-lowering (or insulin) in two groups.Conclusion MPA TDM is beneficial for reducing dosage ofcorticosteroids during maintainance period of immunosuppressive therapy in renal allograft recipients.