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Abstract: FR-PO1200

Plasmapheresis Reduces Mycophenolic Acid Concentration: A Study of Full AUC0-12

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic

Authors

  • Piyasiridej, Sudarat, Chulalongkorn University, Bangkok, Thailand
  • Townamchai, Natavudh, Division of Nephrology, Bangkok, Thailand
  • Udomkarnjananun, Suwasin, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, King Chulalong Memorial lHospital, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
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 AUC0-12 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 AUC0-12 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 AUC0-4 of MPA (23.96 ±28.12% reduction).

Conclusion


Plasmapheresis significantly reduces the level of full AUC0-12 of MPA. The present study is the first to measure the full AUC0-12 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
ParametersDay without PPPP dayp-value
AUC0-1236.79 ±10.2928.22 ±8.21p=001
AUC0-12 reduction (%)19.49 ±24.83 
AUC0-421.78 ±5.6615.79 ±6.46p<0.001
AUC0-4 reduction (%)23.96 ±28.12 

Funding

  • Private Foundation Support