Background: Mycophenolate mofetil (MMF) is a highly effective immunosuppressive agent in transplant therapy. Although MMF is generally well tolerated, optimal therapy may be limited by adverse effects, in particular gastrointestinal (GI) toxicity. MMF dose changes resulting from these adverse events may lead to sub-therapeutic dosing and impaired clinical outcomes. Aim of our study is to investigate the impact MMF dose reduction on the incidence of acute rejection and graft survival.

Methods: In this study, a cohort of 150 kidney transplant recipients who received immunosuppression using MMF in conjunction with cyclosporine and prednisone and Baziliximab induction were evaluated. We classified patients into 3 groups according to MMF dose per day in gm; group I with 2 gm/day, group II 1.5 gm/day and group III 1 gm or less per day. Clinical outcomes were compared and contrasted between patients with and without MMF dose changes within the first year post-transplantation.

Results: The majority of patients (60%) had at least one dose change within the first post-transplant year. Compared with the 60 patients who did not have a dose change, these patients had a significantly higher incidence of acute rejection within the first post-transplant year (13% vs. 3%, p <0.01). This resulted in a significantly decreased 5-yr death-censored graft survival (77% vs. 68% and 57% in the groups I, II and III, respectively, p = 0.04). The incidence of acute rejection for patients who had a dose change was highest if the dose change occurred within the first post-transplant 6 months (38%). The duration to the first acute rejection was dose related (2.3±1.1 and 4.6±1.4 months in group II and III, respectively, p<0.05). Regarding other complications, there was no significant differences in terms of incidence of infections and malignancy within five year of follow-up.

Conclusion: Altering the dose of MMF within the first post-transplant year correlated with a significantly worse clinical outcome in renal transplant recipients. These data suggest that avoidance of MMF dose changes within the first year after renal transplantation would result in improved graft survival.

CITATION INFORMATION: El-Agroudy A, Taher A, Alaradi A, Alhayki B, Gareeb S, Farid E. Mycophenolate Mofetil Dose Reduction Are Associated with the Risk of Acute Rejection and Graft Failure After Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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