肝移植受者的临床霉酚酸监测
Clinical mycophenolic acid monitoring in liver transplant recipients.
作者信息
Chen Hao, Chen Bing
机构信息
Hao Chen, Center of Organ Transplantation and Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China.
出版信息
World J Gastroenterol. 2014 Aug 21;20(31):10715-28. doi: 10.3748/wjg.v20.i31.10715.
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.
摘要
在肝移植中，霉酚酸酯（MMF）的疗效已在临床试验和研究中得到证实。然而，由于尚未对MMF浓度控制与固定剂量处方进行长期前瞻性研究，因此肝移植中对霉酚酸（MPA）的治疗药物监测尚未得到充分认可。本综述探讨了肝移植受者中MPA的测量、药代动力学变异性及其变异原因、与急性排斥反应相关的暴露情况以及MMF相关的副作用。还描述了预测MPA浓度-时间曲线下面积的有限采样策略，其临床应用价值有待未来研究。已发表的数据表明，固定剂量的MMF方案可能不合适，监测MPA暴露在肝移植的各种临床环境中似乎是有帮助的。
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