Outcomes in Kidney Transplant Recipients on Tacrolimus-Based Regimens: A Systematic Review

versibly inhibits inosine monophosphate dehydrogenase to impede B- and T-cell proliferation.1 MMF’s efficacy in renal transplantation was initially demonstrat-ed in 3 pivotal clinical trials.2-4 In a cy-closporine and steroid regimen, MMF 2 g or 3 g daily, compared with placebo or azathioprine, showed significantly lower acute rejection rates at 6 months.2-4 A pooled analysis of these studies also con-firmed MMF’s benefit in preventing re-jection at 1 year.5 Furthermore, MMF was more effective in reducing the risk of chronic allograft failure and improv-ing graft survival at 4 years compared with azathioprine.6 There is some inter-est in concentration-controlled, rather than fixed-dose, MMF regimens in at-tempts to increase efficacy and reduce toxicity. While its clinical role is contro-versial, therapeutic drug monitoring for mycophenolic acid may impact clinical outcomes.7-9 For any given patient, total exposure to mycophenolic acid is best characterized by the area-under-the-con-centration (AUC) time curve. Tacrolimus has become the calcineurin inhibitor of choice in renal transplanta-tion, with tacrolimus and MMF (2 g/day), either with or without a steroid, being one of the most utilized immunosuppressiv