THERAPEUTIC DRUG MONITORING OF MICOPHENOLATE MOFETIL IN CARDIAC TRANSPLANT PATIENTS BY LIMITED SAMPLING STRATEGY: AN UPDATE.

In the last years, many progresses in avoiding acute and cronic rejection in transplanted patinets have been done introducing new and more effective drugs with different formulation, combination and less side effects. Standardised protocols have been proposed for different organs, but individualised therapy based on immunosopressive therapy blood monitoring is necessary becasuse of pharmacologic interaction, new generic drug introduction, different assorption and biodistribution. In specific Mycophenolate Mofetil (MMF) dosing through Mycophenolic Acid (MPA) Therapeutic Drug Monitoring (TDM) has demostrated to minimize the risk of organ transplant rejection. Even if MPA area under the 12 h-concentration-time curve (MPA-AUC0-12) is more accurate than MPA levels, it appears resurce-consuming and clinically impractical because the need of numerous blood samples. The limited sampling strategy (LLS) has been proposed to overcome this problem. In heart transplanted patients MPA LSSs useful in guiding clinical management and dosing. The purpose of this chapter is to describe the state of the art of MPA LSS employement in heart transplantation and to perform an update of the scientific literature.