Kidney Week

Abstract: FR-PO1200

Plasmapheresis Reduces Mycophenolic Acid Concentration: A Study of Full AUC_0-12

Session Information

• Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1901 Transplantation: Basic

Authors

• Piyasiridej, Sudarat, Chulalongkorn University, Bangkok, Thailand

Sudarat Piyasiridej,

• Townamchai, Natavudh, Division of Nephrology, Bangkok, Thailand

Natavudh Townamchai,

• Udomkarnjananun, Suwasin, Chulalongkorn University, Bangkok, Thailand

Suwasin Udomkarnjananun,

• Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand

Somchai Eiam-Ong,

• Tungsanga, Kriang, King Chulalong Memorial lHospital, Bangkok, Thailand

Kriang Tungsanga,

• Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand

Kearkiat Praditpornsilpa,

Background

Mycophenolic acid (MPA), which is a crucial immunosuppressive drug, and plasmapheresis, which is an effective immune reduction method, are simultaneously used for the management of various immune-related diseases, including kidney transplantation. While plasmapheresis has been proven for removing many substances from the blood, its evidence on MPA levels remains unestablished.

Methods

A cross-sectional study was conducted in kidney transplantation recipients who were taking a twice-daily oral dose of mycophenolate mofetil (MMF, Cellcept®) and undergoing plasmapheresis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during January 2018 and January 2019. The MPA levels were measured by enzymatic method (Roche diagnostic®) at 0, 1/2, 1, 2, 3, 4, 6, 8 and, 12 hours for AUC_0-12 calculation on the day with and the day without plasmapheresis sessions. Plasmapheresis was started within 4 hours after the oral morning dose of MMF. Our primary outcome was the difference of AUC_0-12 between the day with and without plasmapheresis.

Results

Forty complete AUC measurements included 20 measurements on the plasmapheresis day and the other 20 measurements on the day without plasmapheresis of six kidney transplant patients. The mean age of patients was 56.2 ±20.7 years. All patients had received MMF 1,000 mg/day for at least 72 hours before undergoing 3.5±1.2 plasmapheresis sessions. Mean AUC on the day with plasmapheresis was lower than the day without plasmapheresis sessions (28.22 ±8.21 vs 36.79 ±10.29 mg x hour/L, p=0.001) and the percentage of AUC reduction was 19.49 ±24.83 %. This was mainly the result of a decrease in AUC_0-4 of MPA (23.96 ±28.12% reduction).

Conclusion

Plasmapheresis significantly reduces the level of full AUC_0-12 of MPA. The present study is the first to measure the full AUC_0-12 in MPA-treated patients undergoing plasmapheresis. Our study suggests that a supplementary dose of MPA in patients undergoing plasmapheresis is necessary.

AUC0-12 on PP and non-PP day

Funding

• Private Foundation Support