Pharmacological Therapeutic Monitoring of Mycophenolate Mofetil (MMF) in Renal Transplant Recipients

Chronic kidney diseases can progress to end-stage renal disease, requiring dialysis or transplantation. Graft rejection remains a major complication, justifying the use of immunosuppressive drugs like Mycophenolate Mofetil (MMF). Therapeutic drug monitoring (TDM) of MMF is essential to balance its beneficial effects and potential side effects. A prospective study was conducted on 30 patients treated with MMF and followed in the nephrology department of the Specialized Hospital Establishment (EHS) Daksi, in Algeria, over a period of 6 months to maintain the area under the curve (AUC) of MMF within the therapeutic range of 30 to 60 h.mg/L. Blood samples for MMF measurement were analyzed using a SIEMENS Viva-ProE immunoassay analyzer at the toxicology laboratory of the University Hospital Center (CHU) of Constantine. Among the 30 patients, the mean AUC was 55.73 ±28.22 h.mg/L, with extreme values ranging from 10.11 to 159.43 h.mg/L. 53.4% of the patients had an AUC within the therapeutic range (balanced), while 46.6% were not balanced, requiring dosage adjustments. The most frequent side effects were digestive disorders (36.67%), infections (6.67%), and hematological problems (3.34%). Patients on MMF and Tacrolimus had higher AUCs than those on Cyclosporine, with respective means of 59.97 ±36.54 h.mg/L and 50.99 ±16.06 h.mg/L. TDM of MMF remains essential to optimize the treatment of kidney transplant recipients, and dosage adjustments based on AUC are recommended to reduce the risk of adverse effects.