JBHI Journal 2026 Journal Article
MPAExpo-LM: Fine-Tuned Large Language Model for Mycophenolic Acid Exposure Estimation After Renal Transplantation
- Dehua Chen
- Huilin Liu
- Qingyuan Ge
- Ming Zuo
- Huimin An
- Quan Zhou
- Shangxi Fu
- Peijun Zhou
An accurate estimation of mycophenolic acid (MPA) exposure after renal transplantation is important for reducing acute rejection in patients treated with mycophenolate mofetil (MMF) or enteric-coated mycophenolate sodium (MPS). We propose MPAExpo-LM, a fine-tuned large language model with a differential attention denoising module for this task. Experiments on real-world datasets demonstrate that MPAExpo-LM achieves superior results compared to existing methods in the task, offering a new pathway for precise immunosuppressive therapy. It attains an RMSE of 8. 78 mg·h/L using three sampling points (C 2, C 4, C 8 ) and 7. 43 mg·h/L with four points (C 0. 5, C 2, C 6, C 8 ). Furthermore, we conducted additional fine-tuning by incorporating a limited amount of data from external data source from another hospital. In the subsequent multi-center validation, the model demonstrated robust generalization, achieving RMSEs of 7. 342 mg·h/L (three points) and 7. 281 mg·h/L (four points). Via reinforcement fine-tuning, the model demonstrates strong generalization capability in cross-hospital tests.