{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:47:41Z","timestamp":1787071661191,"version":"build-2736575974"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Renal transplantation relies on effective immunosuppression. Mycophenolic acid (MPA), the active moiety of mycophenolate mofetil (MMF), is a crucial component. We investigated the relationship between exposure to MPA and early posttransplant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      One hundred and twenty adult live-related renal transplant recipients receiving standard triple immunosuppression (Tacrolimus [Tac] tailored to C\n                      <jats:sub>0<\/jats:sub>\n                      target of 10\u201315 ng\/ml, MMF 1.5\u20132 g\/day and prednisolone) were enrolled. Blood samples were collected to assess MPA exposure, i.e., area under the concentration-time curve (AUC\n                      <jats:sub>0\u201312h<\/jats:sub>\n                      ), 4-weeks after transplantation. Clinical events like rejections and opportunistic infections were monitored during the first 4 weeks posttransplantation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      About two-thirds of participants were males (77:23); the average age of the cohort was 35.86 \u00b1 10.4 years. The mean MPA exposure was 63.7 \u00b1 23.1 \u03bcg \u00d7 h\/mL. 66.6% of the participants had exposure outside the recommended therapeutic window (30\u201360 \u03bcg \u00d7 h\/mL); 55.8% were supra-therapeutic, whereas 10.8% subtherapeutic. Only 33.4% of patients had MPA concentrations within the therapeutic range. The MPA exposure was significantly high for participants who had infection (66.2 \u00b1 26.6 \u03bcg \u00d7 h\/mL,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 24) compared to those who did not (55.3 \u00b1 20.1 \u03bcg \u00d7 h\/mL,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 96,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02). Thirteen patients had rejection, and there was no difference in MPA exposure compared to those who did not (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.8) at 4 weeks. However, it was observed that Tac C0 in patients with history of rejection was higher (13.6 \u00b1 3.3 ng\/ml) compared to those who did not (11.7 \u00b1 3.1 ng\/ml,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005) due to dose up titration at the time of rejection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We found that standard doses of 1.5-2 g\/day MMF lead to overexposure of MPA in the majority of Indian renal transplant recipients in the early posttransplant period, and the higher exposure is linked to infections, underscoring the need for personalized mycophenolate dosing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/iju.iju_43_25","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T11:04:23Z","timestamp":1759230263000},"page":"287-295","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to mycophenolic acid at standard prescribed doses in renal transplantation recipients and clinical outcomes in the early posttransplantation period"],"prefix":"10.4103","volume":"41","author":[{"given":"Sheetal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritika","family":"Panwar","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Naithani","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasika Venkata Kanaka Naga","family":"Kathik","sequence":"additional","affiliation":[{"name":"Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeru","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niveditha","family":"Gowda","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepesh B.","family":"Kenwar","sequence":"additional","affiliation":[{"name":"Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. P. Shiva","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarbpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smita","family":"Pattanaik","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"R1-20251006","first-page":"281","article-title":"Immunosuppressive drugs after solid organ transplantation","volume":"71","author":"van Sandwijk","year":"2013","journal-title":"Neth J Med"},{"key":"R2-20251006","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/s41584-020-0374-8","article-title":"Mycophenolate mofetil, azathioprine and tacrolimus: Mechanisms in rheumatology","volume":"16","author":"Broen","year":"2020","journal-title":"Nat Rev Rheumatol"},{"key":"R3-20251006","doi-asserted-by":"crossref","first-page":"3801","DOI":"10.1021\/cr990097b","article-title":"Mycophenolic acid: A one hundred year odyssey from antibiotic to immunosuppressant","volume":"100","author":"Bentley","year":"2000","journal-title":"Chem 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