Individualised Dosing in Kidney Transplantation: Design of a Mycophenolic Acid Concentration Strategy

Kidney transplantation is the best treatment for end-stage kidney disease. Standard immunosuppression includes prednisolone, tacrolimus, and mycophenolate mofetil (MMF), though MMF dosing strategies vary considerably. This thesis explored optimisation of MMF therapy. Study 1 identified current immunosuppression and MPA (mycophenolic acid) monitoring practices across centres through a multi-national e-survey. Study 2 developed an improved limited-sampling method for monitoring MPA exposure. Study 3 examined associations between MPA exposure and clinical outcomes in children receiving tacrolimus-based regimens after transplantation. Collectively, these studies provide novel evidence to support personalised immunosuppression, aiming to improve post-transplant care and long-term outcomes.