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Serum Trough Concentration and Effects of Mycophenolate Mofetil Based on Pathologic Findings in Infants After Liver

Takehisa Ueno1, Tasuku Kodama1, Yuki Noguchi1

  • 1Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Transplantation Proceedings
|June 24, 2020
PubMed
Abstract

Insights

Infants undergoing living donor liver transplantation require higher doses of mycophenolate mofetil (MMF) to achieve therapeutic levels. Careful monitoring is essential as MMF use in this population may still lead to allograft fibrosis.

Area of Science:

  • Pediatric Transplantation
  • Immunosuppression Therapy
  • Pharmacokinetics

Background:

  • Mycophenolate mofetil (MMF) is a key immunosuppressant in liver transplant recipients.
  • Limited data exists on MMF efficacy and safety in infants post-living donor liver transplantation (LDLT).

Purpose of the Study:

  • To evaluate the efficacy and safety of MMF in infants undergoing LDLT.
  • To determine optimal dosing strategies for MMF in this pediatric population.

Main Methods:

  • Retrospective analysis of infants (<1 year) receiving LDLT and MMF.
  • Dose adjustments based on mycophenolic acid (MPA) trough levels (target: 2 mg/L).
  • Assessment of acute cellular rejection (ACR), fibrosis, and adverse events.

Main Results:

  • Higher MMF doses (mean 66 mg/kg/d) were needed to reach target MPA trough levels (mean 2.7 mg/L) in infants.
  • Allografts showed mild to moderate fibrosis (F1-F2).
  • Discontinuation due to infection and bone marrow suppression occurred in two patients.

Conclusions:

  • Infants require higher MMF doses post-LDLT compared to older patients.
  • Despite adequate MMF levels, allograft fibrosis progression remains a concern.
  • Individualized MMF dosing and monitoring are crucial in pediatric LDLT.

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