Concomitant Proton Pump Inhibitors With Mycophenolate Mofetil and the Risk of Rejection in Kidney Transplant Recipients

Abstract

In this retrospective study, PPI use in the first transplant year was associated with an increased risk for BPAR in black patients but not in non-black patients. It is possible that a reduction in mycophenolic acid exposure contributed to the increased risk.

Renal Transplant Acute Rejection with Lower Mycophenolate Mofetil Dosing and Proton Pump Inhibitors or Histamine‐2 Receptor Antagonists

“…This corroborates that deceased donor transplant still imparts higher risk compared to living donor organs despite improved immunosuppression regimens . These results support prior studies that failed to demonstrate significant acute rejection differences for patients taking MMF–PPI versus MMF–H2RA, despite differences in methodology …”

“…While the current results regarding acute rejection were nonsignificant and mirrored those of previous studies, we believe that they are a significant addition to the literature due to the initial lower MMF dosing used . If concomitant MMF–PPI leads to lower MPA exposure and subsequently increased rejection risk (vs H2RAs), this effect should be magnified in those taking a lower MMF regimen; however, the current results did not support this hypothesis.…”

“…A group of researchers compared 1‐year BPAR in patients taking MMF with a PPI versus patients taking MMF with ranitidine. All patients received antithymocyte globulin for induction, a calcineurin inhibitor (> 97% on tacrolimus), steroids, and MMF 2 g/day.…”

“…A multivariable logistic regression analysis was performed to assess for covariates independently associated with 1‐year acute rejection. Model covariates included variables found to be statistically significant on univariate analysis, those shown to independently affect acute rejection risk previously, and other clinically plausible risk factors . Odds ratios (ORs) and 95% confidence intervals (CIs) are presented for logistic regression analysis results.…”

“…Several pharmacokinetic (PK) studies have illustrated this with concomitant MMF–PPI therapy yielding an approximately 30% decrease in MPA area under the curve . Recently, two retrospective studies investigated clinical implications of concomitant MMF–PPI use in renal transplant recipients . Neither study found a statistically significant difference in acute rejection rates between patients taking MMF and a PPI compared to those taking MMF and an H2RA.…”