Feasibility and Preliminary Outcomes of Area Under the Concentration-Time Curve (AUC)-Guided Tacrolimus and Mycophenolate Dosing in Pediatric Kidney Transplant Recipients.

BACKGROUND

This pilot study evaluated the feasibility of integrating an immunosuppressant area under the concentration-time curve (AUC) monitoring for tacrolimus and mycophenolic acid (MPA) into pediatric kidney transplantation care.

METHODS

Dedicated test codes, an AUC requisition form, and a coordinated laboratory sampling process were established for tacrolimus and MPA AUC. AUC was calculated using the ISBA 3.0 Bayesian pharmacokinetic platform. AUC results were correlated with doses, trough concentrations (C0), 3 h post-dose concentrations (C3h), and clinical outcomes.

RESULTS

The AUC protocol was successfully integrated into the routine clinical workflow. Tacrolimus AUC showed correlations with dose (r = 0.85) and C0 (r = 0.82); similarly, MPA AUC showed correlation with dose (r = 0.61) and C3h (r = 0.65). Of the 21 Tacrolimus AUC measurements, 76% were within the target range, and 24% were below the range. For MPA AUC measurements, 65% (13/20) were within the target range, 5% (1/20) were below the range, and 30% (6/20) were above the range. Following individual AUC measurements, the tacrolimus dose was adjusted after 43% (9/21) of measurements, and the mycophenolate mofetil (MMF) dose was adjusted after 50% (10/20) of measurements.

CONCLUSION

This AUC pilot study demonstrated the feasibility of integrating AUC-guided monitoring into the routine management of pediatric kidney transplant recipients.