Monitoring levels of immunosupressive medications – is it just a recommendation or a necessity?
Journal Title: Postępy Nauk Medycznych - Year 2014, Vol 27, Issue 2
Abstract
Introduction. Enormous development of organ transplantation which took place in recent years was made possible also due to development of more diverse and targeted immunosupression. Huge progress in this area was achieved due to inroduction of calcineurin inhibitors, m-TOR inhibitors, mono- and polyclonal antibodies, and drugs containind mycophenolic acid. Nonetheless, administration of these drugs, in dfferent combinations and doses, can lead to numerous side effects. Therefore, patients after transplantation of vascular organs require regular and thorough clinical follow-up, as well as individually tailored dose of immunospuressive drugs and and monitoring its blood concentration. Currently such strategy it is commonly accepted for calcineurin inhibitors and m-TOR inhibitors, but a discusssion among transplantologists takes place about necessity of monitoring blood levels of mofetil mycophenolate or natrium mycophenolate.Aim. The aim of this paper is to assess usefulness of monitoring blood levels of mofetil mycophenolate (MMF) in patients after kidney transplantation , based on published literature and our own clinical studies.Material and methods. Immunoenzymatic method (EMIT) was used to calculate area under curve (AUC) for each of three consecutive blood samples in 21 patients (23 results).Results. In several cases, achieved results were far outside the recommended limits (30-60 mg h/l), which resulted in necessity to correct drug dose. Therefore it seems that, in selected cases, monitoring MMF levels can be useful in selection of optimal drug dose and can lead to lower risk of side effects and possible rejection reactions.Conclusions. Literature data and our own observations support the thesis that monitoring blood levels of mofetil mycofenolate (and possibly in the future also natrium mycofenolate), especially in the early post-operation period, will be the standard of care in patients after vascular organ transplantation.
Authors and Affiliations
Krzysztof Dziewanowski, Radosław Drozd, Elżbieta Krzysztolik
Keywords
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