Purpose: The primary objective was to evaluate the effect of mycophenolate (MPA) dicharge (DC) dose on pancreas allograft (PTX) survival. Secondary endpoints included patient survival (PS), rejection, infection and time to initial MPA dose decrease.

Methods: Adult PTX recipients transplanted 1/1/2002-6/30/2015 were divided into cohorts based on MPA dose at DC; high dose (HD) – 1000 mg TID mycophenolate mofetil (MMF) or equivalent and standard dose (SD) – 1000 mg BID MMF or equivalent. Multivariable models were performed to adjust for presence of confounding risk factors.

Results: Demographics were matched between groups with no difference in transplant number, recipient BMI or age (Table 1). There was a disproportionate amount of males in HD group (HD 64.5% vs SD 50.3%, p=0.001). In a univariate analysis, graft survival was improved in the HD group at 1, 3 and 5 years (81.4, 76.1 and 69% vs 91.9, 84.1 and 77.4%, p=0.046). After adjustment for confounding risk factors there was a near significant difference across allograft subtypes (p=0.08). When censoring PAK/PTA, MPA dose had significant impact on graft failure in the SPK group (HR 1.6, p=0.007). PS, rejection and infection did not differ (p=0.4, 0.6, and 0.5). The HD group required more frequent and earlier dose reduction than the SD group [n=400, 80.9% vs n=120, 65.6%, p=0.0001), average 92.6 ± 69.3 vs 74.3 ± 72.5 days, p=0.01]

Conclusions: Use of HD MPA at PTX DC improved graft survival overall. In a subgroup analysis by allograft type dose had a significant impact on pancreas survival in SPK recipients.

CITATION INFORMATION: Fose J, Rolling K, Menninga N, Leverson G, Jorgenson M, Odorico J, Robert R. Impact of Intensive Dosing of Mycophenolate on Pancreas Allograft Survival. Am J Transplant. 2017;17 (suppl 3).

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