A simple to use tool for calculating mycophenolic acids area under the curve (MPA-AUC) concentration based on three input values in the care of kidney transplant patients. This implementation is designed by Dr Michał Bartoszek.

The single most used immunosuppressant in solid-organ transplantation is mycophenolate mofetil (MMF).[1,2,3,4] Despite well-documented relationship between efficacy in terms of acute rejection prophylaxis and exposure to mycophenolic acids (MPA, active form of MMF)[5] as measured by area under the curve (AUC), excellent results have been achieved using a fixed-dosage regimen.[1,4,6,7] There has been recently an increased interest in the possibility of monitoring MPA concentrations for increasing efficacy and decreasing toxicity, in current drug minimisation protocols. The present findings[8] suggest the MPA-AUC of 30-60 mg*h/l in the maintenance stage of renal transplant patients to have optimal both clinical benefit and adverse events profile indicating the usefulness of AUC of MPA with limited sampling strategy (the model using c0h, c0.5h, and c2h suggests to be superior to all other models) in optimising its use.[7]

MPA-AUC calculator is a tool that can help to identify patients who are out of the current target ranges. Having it easily accessible on iOS device facilitates every day practice tasks for health care professionals dealing with kidney transplant recipients. 

References:

1. van Gelder T, Silva HT, de Fijter JW, Budde K, Kuypers D, Tyden G, Lohmus A, Sommerer C, Hartmann A, Le Meur Y, Oellerich M, Holt DW, Tönshoff B, Keown P, Campbell S, Mamelok RD. Comparing mycophenolate mofetil regimens for de novo renal transplant recipients: the fixed-dose concentration-controlled trial. Transplantation 2008 Oct 27;86(8):1043-51.

2. Iain A. M. MacPhee, Jiří Froněk (editors). Handbook of Renal and Pancreatic Transplantation. John Wiley & Sons, Inc. 2012 (available from www.onlinelibrary.wiley.com ISBN: 9781118305294)

3. Höcker B, van Gelder T, Martin-Govantes J, Machado P, Tedesco H, Rubik J, Dehennault M, Garcia Meseguer C, Tönshoff B; FDCC Study Group. Comparison of MMF efficacy and safety in paediatric vs. adult renal transplantation: subgroup analysis of the randomised, multicentre FDCC trial. Nephrol Dial Transplant. 2011 Mar;26(3):1073-9.

4. Jeong H, Kaplan B. Therapeutic Monitoring of Mycophenolate Mofetil. Journal of the American Society of Nephrology (CJASN), 2007 January vol.2 no.1: 184-191

5. Dalal P, Grafals M, Chhabra D, Gallon L. Mycophenolate mofetil: safety and efficacy in the prophylaxis of acute kidney transplantation rejection. Ther Clin Risk Manag. 2009 Feb;5(1):139-49.

6. Kuypers DR, Le Meur Y, Cantarovich M, Tredger MJ, Tett SE, Cattaneo D, Tönshoff B, Holt DW, Chapman J, Gelder Tv; Transplantation Society (TTS) Consensus Group on TDM of MPA. Consensus Report on Therapeutic Drug Monitoring of Mycophenolic Acid in Solid Organ Transplantation. Clinical Journal of the American Society of Nephrology (CJASN) February 2010 vol. 5 no. 2: 341-358

7. Pawinski T, Hale M, Korecka M, Fitzsimmons WE, Shaw LM. Limited Sampling Strategy for the Estimation of Mycophenolic Acid Area under the Curve in Adult Renal Transplant Patients Treated with Concomitant Tacrolimus. Clinical Chemistry, 2002 Sep;48(9):1497-504.

8. Kuypers DR, de Jonge H, Naesens M, de Loor H, Halewijck E, Dekens M, Vanrenterghem Y. Current target ranges of mycophenolic acid exposure and drug-related adverse events: a 5-year, open-label, prospective, clinical follow-up study in renal allograft recipients. Clinical Therapeutics, 2008 Apr;30(4):673-83.