Mycophenolate Mofetil in Pediatric Renal Transplantation

Abstract

Mycophenolate mofetil (MMF) has become a popular immunosuppressive agent in pediatric renal transplantation and has helped to address the unique challenges of transplantation in this population. This paper reviews the early studies that proved MMF's efficacy in reducing the risk of acute renal rejection, as well as its safety and tolerability in comparison to azathioprine. Key conclusions about the pharmacokinetics of MMF from studies of MMF alone and in combination with other immunosuppressive therapies are outlined. The importance of therapeutic drug monitoring (TDM) in this population is also explored in this review. Finally, recent studies showing that newer agents used in combination with MMF can further increase efficacy and reduce the risk of adverse events such as posttransplant lymphoproliferative disease are discussed.

Mycophenolate mofetil in dermatology

“…9 Pediatric use MMF has been successfully used in the pediatric population for the prevention of renal transplant rejection. 159 In dermatology, there have been reports of its use, with much lower frequency than that in the adult population. It was reported to be successful in a case of childhood immunoglobulin A (IgA)emediated epidermolysis bullosa acquisita.…”

Consensus Report on Therapeutic Drug Monitoring of Mycophenolic Acid in Solid Organ Transplantation

“…The first study on MPA pharmacokinetics in pediatric renal allograft recipients showed that MMF dosages of 23 and 30 mg/kg yielded MPA exposure (AUC 0 to 12 hours ) in the same range as derived from adult studies of approximately 30 mg ϫ h/L (91). Closer analysis of the pharmacokinetics indicated that pediatric MMF dosage could be determined more accurately when calculated on the basis of body surface area and that this target could be achieved using a starting dosage of 600 mg/m 2 per dose (1200 mg/m 2 per d) in patients on concomitant CsA therapy (91). This body surface area-related MMF dosing leads to a comparable MPA exposure over the entire pediatric age range (14).…”

“…When MMF needs to be reduced or discontinued (in approximately 13 to 16% of pediatric recipients), the reasons are usually gastrointestinal (e.g., nausea, upper abdominal pain, diarrhea) and hematologic (e.g., leucopenia, anemia) (94,95). It was assumed that temporary discontinuation of MMF had no effect on acute rejection; however, this may not be the case, particularly in patients who are treated with a steroid-free reg-imen.…”

Comparison of high-performance liquid chromatography and enzyme-multiplied immunoassay technique to monitor mycophenolic acid in paediatric renal recipients

“…These reported target values are similar in adults and children, although there are conflicting reports on the values of TDM pharmacokinetics parameters in predicting outcome in paediatric patients [4,33,34]. The dose required to obtain MPA AUC within the therapeutic range was investigated in a few paediatric studies that differed in patients' ages, post-transplantation delay and associated immunosuppressants.…”

“…It is increasingly prescribed in paediatric renal transplantation, often replacing azathioprine, in combination with a calcineurin inhibitor [4]. Indeed, it reduces the occurrence of acute rejection in comparison with azathioprine and is well tolerated, without nephrotoxicity or cosmetic side effects [5].…”