Clinical Significance of Mycophenolate Mofetil Withdrawal in Kidney Transplant Recipients

Park, Woo Yeong; Paek, Jin Hyuk; Jin, Kyubok; Park, Sung Bae; Han, Seungyeup

doi:10.1016/j.transproceed.2019.03.061

Cited by 10 publications

(15 citation statements)

References 8 publications

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“…There are many reasons for MMF reduction or withdrawal. Park et al [18], in a retrospective analysis with induction and maintenance immunosuppression similar to our study, found that the common causes of discontinuation of MMF were infections (70.7%) but when they analyzed the different groups (continuation or withdrawal of MMF) in the long term, they no found differences in the incidence of CMV and BK. In the present cohort, we found no statistical significance with UTI and CMV between the groups, and BK nephropathy was not demonstrated through decoy cells in any histopathological result; although, the disadvantage of our study was lack of measurement of the viral load for BK.…”

Section: Discussionsupporting

confidence: 77%

“…Given the known pharmacokinetic and pharmacodynamic interactions whereby TAC increases MPA exposure and CsA does not, the concomitant use of TAC and MMF allows a theoretical reduction in MMF doses after RT with good results in terms of graft and patients survival during the first year after transplantation [17]; however, avoiding, suspending, or employing doses lower than 1g could increase the risk of AR. [18,19] In our hospital, 97% of RT is from a living donor and the standard dose of 2g/day of MMF with TAC is used in the immediate post-RT period without taking into account the serum concentrations of MPA since this is impractical and economically unfeasible in our health care system considering the nonlinear absorption kinetics. Immunosuppression reduction is a clinical challenge, our experience in this field is based to steroid reduction [3,4,20], however clinical protocols in our setting allows to consider other pharmacological reductions i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Immunosuppression reduction is a clinical challenge, our experience in this field is based to steroid reduction [3,4,20], however clinical protocols in our setting allows to consider other pharmacological reductions i.e. MMF, there is an international evidence in MMF reduction with controversial [18,19,[21][22][23][24][25] results, in Latin America there is not experience regarding this topic; Nevertheless, since the early post-transplant stages could considered the relatively low incidence of AR under the immunosuppressive regimens with TAC especially in low immunological risk patients clinicians find themselves having to reduce the doses of MMF, empirically, due to the presence of adverse effects. Thus, an actual tendency in our setting is to initiate, in the immediate post-transplant period, a dose of 1.5g/day.…”

Section: Introductionmentioning

confidence: 99%

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Clinical impact using low dose mycophenolate mofetil with tacrolimus on acute rejection, infectious diseases and non-infectious complications in renal transplant: A Single Hospital Experience in Mexico

Andrade‐Sierra

Hernández-Reyes

Rojas‐Campos

et al. 2022

Preprint

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Background. The evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) in renal transplant (RT) is still limited but maintaining the dose of less than 2g could result in worse clinical outcomes in terms of acute rejection (AR). Research Question: This study aim was to determine the association between AR, infectious and non-infectious complications after RT with the dose of 1.5g vs. 2g of MMF. Design. A prospective cohort was performed with a 12-month follow-up in recipients of RT from living donors with low doses of MMF (1.5 g/day) or use of standard dosage (2 g/day). The association between adverse effects and complications and doses of MMF were examined in Cox proportional hazard models and survival free of AR, infectious diseases, and non-infectious complications was evaluated by the Kaplan-Meier test. Results. At the end of the follow-up, the incidence of infectious diseases was 52% vs. 50% (p=0.71) and AR was 5% vs. 5% (p=0.86), respectively. Survival free of GI complications requiring medical attention was higher in the low dose group compared to the standard dose (88% vs. 45%, respectively; p<0.001). Discussion. The use of 1.5 g/day of MMF is safe in Mexican population with RT from living donors without increasing the risk of AR, and it confers a reduction of adverse events.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical impact using low dose mycophenolate mofetil with tacrolimus on acute rejection, infectious diseases and non-infectious complications in renal transplant: A Single Hospital Experience in Mexico

Andrade‐Sierra

Hernández-Reyes

Rojas‐Campos

et al. 2022

Preprint

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“…Most of the other kidney transplant recipients were on TAC‐based and EVR‐based regimens plus additional MMF to prevent de novo donor‐specific antibody production; MMF cessation for 7 days was safe in kidney transplant recipients on this triple‐drug regimen. Although MMF withdrawal for prolonged period increases the risk of rejection and deterioration of graft survival, 10 cessation of MMF for 3 to 7 days did not result in any rejection episode within the 6 months after the second vaccination. However, the limitation of this interim analysis is that the long‐term effect on the production of de novo donor‐specific antibodies is unclear and still under investigation in our ongoing study.…”

Section: Discussionmentioning

confidence: 84%

Temporary reduction of immunosuppression enhances production of anti‐S antibody against severe acute respiratory syndrome coronavirus 2 after vaccination in kidney transplant recipients

et al. 2022

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Objectives The study identified factors affecting anti‐S immunoglobulin G production after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in kidney transplant recipients. Methods Serum samples were prospectively collected from kidney transplant recipients, live kidney donors, and healthy volunteers 1 month after receiving the second dose of SARS‐CoV‐2 vaccine, and anti‐S immunoglobulin G titers were measured. The mycophenolate mofetil dose was reduced before vaccination in some immunologically low‐risk recipients. Results A total of 151 kidney transplant recipients, 74 live kidney donors, and 50 healthy volunteers were included. Kidney transplant recipients had significantly lower titers of anti‐S immunoglobulin G than donors and healthy volunteers (1377 ± 246, 8310 ± 932, and 9908 ± 1040 AU/ml, respectively). Only 67.3% of kidney transplant recipients, compared to 100% of donors and healthy volunteers, were positive for anti‐S immunoglobulin G. Among the kidney transplant recipients, the anti‐S titer was higher in younger recipients, those with higher peripheral blood lymphocyte counts and glomerular filtration rates, those without a history of antithymocyte globulin use, and those who had discontinued or received a reduced dose of mycophenolate mofetil. Younger age, higher lymphocyte count, glomerular filtration rate, and mycophenolate reduction were significantly associated with anti‐S immunoglobulin G > 1000 AU/ml in nominal logistic regression analysis. There were no rejection episodes after mycophenolate modification in kidney transplant recipients. Conclusions Anti‐S immunoglobulin G production after vaccination was attenuated in kidney transplant recipients. Mycophenolate mofetil cessation or reduction is a modifiable means to enhance anti‐S immunoglobulin G production in immunosuppressed kidney transplant recipients.

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“…98,151,[153][154][155] However, the certainty levels of the evidence are low to very low because most studies are nonrandomized trials, limited by small sample sizes and therefore insufficient power, with highlevel of imprecision, and inclusion of transplant eras where screening for BKPyV infection was poorly described or not widely practised. 156 e81…”

Section: Dose Reduction or Withdrawal Of Immunosuppressantsmentioning

confidence: 99%

Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management

et al. 2021

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Polyomavirus BK virus (BKPyV) infection is an important complication of kidney transplantation and allograft failure. The prevalence of viremia is 10%-15%, compared with BK-associated nephropathy (BKPyVAN) at 3%-5%. Given that there are no effective antiviral prophylaxis or treatment strategies for BKPyVAN, active screening to detect BKPyV viremia is recommended, particularly during the early posttransplant period. Immunosuppression reduction to allow viral clearance may avoid progression to severe and irreversible allograft damage. The frequency and duration of screening are highly variable between transplant centers because the evidence is reliant largely on observational data. While the primary treatment goals center on achieving viral clearance through immunosuppression reduction, prevention of subsequent acute rejection, premature graft loss, and return to dialysis remain as major challenges. Treatment strategies for BKPyV infection should be individualized to the recipient's underlying immunological risk and severity of the allograft infection. Efficacy data for adjuvant therapies including intravenous immunoglobulin and cidofovir are sparse. Future well-powered and high-quality randomized controlled trials are needed to inform evidence-based clinical practice for the management of BKPy infection.

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Clinical Significance of Mycophenolate Mofetil Withdrawal in Kidney Transplant Recipients

Cited by 10 publications

References 8 publications

Clinical impact using low dose mycophenolate mofetil with tacrolimus on acute rejection, infectious diseases and non-infectious complications in renal transplant: A Single Hospital Experience in Mexico

Clinical impact using low dose mycophenolate mofetil with tacrolimus on acute rejection, infectious diseases and non-infectious complications in renal transplant: A Single Hospital Experience in Mexico

Temporary reduction of immunosuppression enhances production of anti‐S antibody against severe acute respiratory syndrome coronavirus 2 after vaccination in kidney transplant recipients

Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management

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