We have previously reported a poor correlation between Cyclosporine A (CsA) whole blood level and both graft outcome and lymphocyte (Lc) count in kidney transplant patients. This study was conducted to determine the relationship between the clinical diagnosis, the state of immunosuppression as reflected by the total Lc count, and the Mycophenolic Mofetil (MMF) plasma trough levels (MT0L) and dose, in recipients of renal transplants. MT0L was determined in thirty (30) kidney transplant patients, of whom seven exhibited biopsy-proven acute rejection (REJ), while the remaining 23 had a normal graft function (NORM). Graft outcome defined by clinical diagnosis and serum creatinine (Scr) was compared according to MMF MT0L, dose and Lc count. MMF monitoring parameters (level and dose) were analyzed among each other and in relation to the Lc count.
Rejection 0.5g) and Lc 1.7 ng/ml), dose (1.7 (REJ) patients had similar MMF MT0L (2.4 0.7 ng/ml, 1.7 404 / ml) when compared to NORM patients (2.2 count (1165 527 / ml) respectively. Scr was significantly higher in the REJ 0.4 g and 1160 0.2 mg/dl, p 0.1 mg/dl vs 1.0 group than in the NORM one (1.5 < 0.01). While rejection rates were comparable irrespective of MT0L, they were however significantly higher in the 1g dose (30%) when compared to the 1.5 g and 2 g doses (12.5% and 11.7%) respectively. No relationship was observed between MT0L and MMF dose (R: 0.16) and both parameters failed to correlate with the Lc count (R: 0.24), R: 0.28) respectively. These results suggest that MMF plasma trough levels (MT0L) are poor correlates of the clinical outcome and the state of immunosuppression. Although the usually recommended doses of MMF (2g) may be associated with acute rejection, low dose MMF (1g) seems to constitute a higher risk.