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This study investigated the effect of early post\u2010transplant pharmacokinetics (PK) of MPA and Tacrolimus along with the pharmacodynamics (PD) of MPA on biopsy\u2010proven acute rejection (BPAR) after renal transplantation. A prospective PK\/PD study with limited sampling (three blood samples) was conducted in renal transplant recipients on week 1, around Day 6 (<jats:italic>n<\/jats:italic>\u00a0=\u00a042) and at the 3rd\u2010month biopsy on Day 90 (<jats:italic>n<\/jats:italic>\u00a0=\u00a023). The partial exposures (area under curve [AUC]<jats:sub>0\u20103.5\u00a0h<\/jats:sub>) of both MPA and Tacrolimus obtained during the first week were more predictive of rejection (combined clinical and subclinical rejection) by Day 90 than their trough concentrations or Day 90 exposures. Patients with rejection had significantly worse renal function (eGFR) and a comparatively lower exposure to MPA during the first post\u2010transplant week. The lower MPA exposure was also associated with sub\u2010optimal inosine monophosphate dehydrogenase (IMPDH) inhibition in patients with rejection, and the probability of rejection was higher in the presence of an increased pre\u2010transplant IMPDH activity. A composite of parameters, including MPA exposure and IMPDH activity was found to predict acute rejection and may be beneficial along with tacrolimus monitoring early after renal transplantation.<\/jats:p>","DOI":"10.1111\/ctr.14830","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T09:09:47Z","timestamp":1664528987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The combination of exposure to Tacrolimus, mycophenolic acid, Inosine 5\u2032\u2010Monophosphate Dehydrogenase activity and inhibition in the first week define early histological outcomes in renal transplant recipients"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-0733","authenticated-orcid":false,"given":"Harisudhan","family":"Thanukrishnan","sequence":"first","affiliation":[{"name":"School of Pharmacy University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raman","family":"Venkataramanan","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajil B.","family":"Mehta","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0503-4707","authenticated-orcid":false,"given":"Puneet","family":"Sood","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfh739"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2005030249"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02966.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14627"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01230.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13318"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001163"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.03.028"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000128167.60172.CC"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318169c48d"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V11suppl_1s1"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9236(98)90058-3"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9120(98)00056-3"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199907270-00018"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/48.3.517"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200304000-00003"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200108000-00001"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002762"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318186f98a"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ftd.0000199358.80013.bd"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2005101070"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00455.x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-6143.2003.00079.x"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200002000-00003"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000871"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.01983.x"},{"key":"e_1_2_8_28_1","unstructured":"Genentech USA Inc.Cellcept (mycophenolate mofetil) [package insert]. 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