{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:29:19Z","timestamp":1753878559300,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pharmacokinetics of mycophenolic acid (MPA) display substantial interpatient variability, with up to 10\u2010fold difference of exposure in individual patients under a fixed\u2010dose regimen. MPA trough level (C0) monitoring is common in clinical practice but has not proven sufficiently informative in predicting MPA exposure or patient outcomes, especially in children. No limited sampling strategies (LSSs) have been generated from pediatric heart transplant (HTx) recipients to estimate MPA AUC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Single\u2010center, observational analysis of 135 <jats:italic>de novo<\/jats:italic> pediatric HTx recipients \u226421\u00a0years old who underwent MPA AUC between 2011 and 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age was 4\u00a0years (IQR .6\u201312.1). Median time from transplant to MPA AUC sampling was 15\u00a0days (IQR 11\u201319). MMF doses (mg or mg\/day) had low, negative Pearson correlation coefficients (r) while doses adjusted for weight or body surface area had low correlation with Trapezoidal MPA AUC<jats:sub>0\u201324\u00a0h<\/jats:sub> (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.3 and .383, respectively). MPA C0 had weak association (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.451) with Trapezoidal MPA AUC<jats:sub>0\u201324\u00a0h<\/jats:sub>. LSS with two pharmacokinetic sampling time points at 90 (C<jats:sub>3<\/jats:sub>) and 360 (C<jats:sub>5<\/jats:sub>)\u00a0min after MMF administration (estimated AUC<jats:sub>0\u201324\u00a0h<\/jats:sub>\u00a0=\u00a032.82\u00a0+\u00a04.12\u00a0\u00d7\u00a0C<jats:sub>3<\/jats:sub>\u00a0+\u00a011.53\u00a0\u00d7\u00a0C<jats:sub>5<\/jats:sub>) showed strong correlation with Trapezoidal MPA AUC<jats:sub>0\u201324\u00a0h<\/jats:sub> (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.87).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MMF at fixed or weight\u2010adjusted doses, as well as MPA trough levels, correlate poorly with MPA AUC<jats:sub>0\u201324\u00a0h<\/jats:sub>. We developed novel LSSs to estimate Trapezoidal MPA AUC from a large cohort of pediatric HTx recipients. Validation of our LSSs should be completed in a separate cohort of pediatric HTx recipients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15087","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T13:48:35Z","timestamp":1690897715000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mycophenolic acid therapeutic drug monitoring using area under the curve in pediatric heart transplant recipients"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-8065","authenticated-orcid":false,"given":"David M.","family":"Newland","sequence":"first","affiliation":[{"name":"Department of Pharmacy Seattle Children's Hospital Seattle Washington USA"},{"name":"School of Pharmacy University of Washington Seattle Washington 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L.","family":"Nemeth","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Seattle Children's Hospital Seattle Washington USA"},{"name":"School of Pharmacy University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5738-0786","authenticated-orcid":false,"given":"William","family":"Tressel","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-7076","authenticated-orcid":false,"given":"Richard A.","family":"Kronmal","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa R.","family":"Knorr","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Seattle Children's Hospital Seattle Washington USA"},{"name":"School of Pharmacy University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3072-4195","authenticated-orcid":false,"given":"Erin L.","family":"Albers","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Seattle Children's Hospital Seattle Washington USA"},{"name":"School of Medicine University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6161-7651","authenticated-orcid":false,"given":"Joshua M.","family":"Friedland\u2010Little","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Seattle Children's Hospital Seattle Washington USA"},{"name":"School of Medicine University of Washington Seattle Washington 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