Nakamura Eisuke, Sofue Tadashi, Kunisho Yasushi, Onishi Keisuke, Yamaguchi Kazunori, Ibuki Emi, Taoka Rikiya, Ueda Nobufumi, Sugimoto Mikio, Minamino Tetsuo
Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, Kagawa, Japan.
Department of Pharmacy, Kagawa University Hospital, Takamatsu 761-0793, Kagawa, Japan.
J Pers Med. 2021 Nov 18;11(11):1224. doi: 10.3390/jpm11111224.
Mycophenolate mofetil is a key immunosuppressant that is metabolized into mycophenolic acid (MPA). The prognostic impact of MPA-focused therapeutic drug monitoring on allograft prognosis has not been determined in kidney transplant recipients with diabetes. In this study, we assessed the pharmacokinetics of MPA and allograft prognosis in recipients with diabetes. This study retrospectively analyzed 64 adult kidney transplant recipients. MPA blood concentration data (e.g., the time to the maximum concentration (Tmax), and the area under the concentration-time curve from 0 to 12 h (AUC)) were collected at 3 weeks and 3 months after kidney transplantation. Of the 64 recipients, 15 had pre-existing diabetes. At 3 months after kidney transplantation, the Tmax of MPA was significantly longer in recipients with diabetes (mean (standard deviation): 2.8 (2.1) h) than in recipients without diabetes (1.9 (1.1) h, = 0.02). However, the allograft estimated glomerular filtration rate and acute rejection rate, including borderline change, did not differ according to the diabetes status in patients with adjusted AUC of MPA within the target range. In conclusion, a longer Tmax of MPA was observed in recipients with diabetes; however, acceptable allograft prognosis was observed in kidney transplant recipients with diabetes and a sufficient AUC of MPA.
霉酚酸酯是一种关键的免疫抑制剂，可代谢为霉酚酸（MPA）。在糖尿病肾移植受者中，以MPA为重点的治疗药物监测对移植肾预后的影响尚未确定。在本研究中，我们评估了糖尿病受者中MPA的药代动力学和移植肾预后。本研究回顾性分析了64例成年肾移植受者。在肾移植后3周和3个月收集MPA血药浓度数据（例如，达峰时间（Tmax）以及0至12小时的浓度-时间曲线下面积（AUC））。在这64例受者中，15例有糖尿病病史。肾移植后3个月，糖尿病受者中MPA的Tmax（均值（标准差）：2.8（2.1）小时）显著长于无糖尿病受者（1.9（1.1）小时，P = 0.02）。然而，在MPA调整后的AUC在目标范围内的患者中，移植肾估计肾小球滤过率和急性排斥率（包括临界变化）根据糖尿病状态并无差异。总之，糖尿病受者中观察到MPA的Tmax较长；然而，在糖尿病肾移植受者中且MPA的AUC充足时，观察到了可接受的移植肾预后。
