Differences And Influencing Factors Of Mycophenolic Acid Concentration In Different Age Groups In Pediatric Kidney Transplantation

Objective To investigate the exposure difference of mycophenolic acid(MPA)between children in different age groups and the related influencing factors after kidney transplantation,and provide reference for adjusting immunosuppression program in pediatric kidney transplantation recipients.Method A retrospective analysis was performed on patients receiving deseaced donor(DD)in the Department of Kidney Transplantation of the First Affiliated Hospital of Zhengzhou University from May 2017 to January 2022.Seventy-three pediatric renal transplant recipients were treated with tacrolimus+mycophenolic acid(MMF or EC-MPS)+steroid after surgery.The two groups were divided into group A(<12 years old)and group B(≥12 years old)according to age,and the differences of MPA concentration between the two groups and the possible influencing factors of MPA concentration were compared.Two groups’ adverse reaction rates which related to MPA concentration were compared.Result1.MPA concentration in group A was higher than that in group B(P<0.05).2.There were no significant differences in hemoglobin,plasma albumin,AST and ALT levels between the two groups(P>0.05).3.There was no significant difference in MPA concentration between groups A and B taking MMF(P>0.05),and MPA concentration in group A taking EC-MPS was significantly higher than that in group B(P<0.05).MPA concentration in group A taking EC-MPS was higher than that taking MMF,but there was no significant difference(P>0.05).4.The incidences of DSA in low,medium and high MPA-AUC exposure groups are 40%,20.8%,and 15%,respectively.And the DSA incidence in low exposure group was higher than that in medium and high MPA-AUC exposure groups,but the difference was not statistically significant(P>0.05).There was no significant difference in the incidence of DSA between groups A and B(25%vs.20.5%,x2=0.692,P=0.406).5.There were 2 cases of acute rejection in group B,and the infection rate of group A(21.9%)was higher than that of group B(9.8%),but the difference was not statistically significant(P=0.194).Conclusion By analyzing the difference of MPA concentration in different age groups,the factors that may influence MPA concentration were compared,and the incidence of adverse reactions related to MPA concentration was compared.It is concluded that the factor of age have a greater influence on MPA drug concentration,and MPA concentration is higher in children whose age≤12 years old than children>12 years old,which may lead to corresponding adverse reactions.This effect may be different for different drug forms,mainly for those taking EC-MPS.In addition,it is very important to conduct therapy drug monitoring for narrow treatment window drugs.It is necessary to conduct regular drug monitoring for pediatric kidney transplant recipients,formulate improvement and rationalization of individual drug use program,improve the management program of children kidney transplantation,and improve the quality of children kidney transplantation.