Purpose: The ideal minimizing strategy for maintenance immunosuppression in HLA-matched kidney transplant recipients (KTR) is unknown. We hypothesized that mycophenolate (MPA) monotherapy is a safe and effective approach for maintenance therapy in this group of KTR.

Methods: Data were abstracted for HLA-matched KTR between 1994 and 2013. Those on MPA monotherapy were matched to recipients not on MPA monotherapy based on age, sex, cause of end-stage renal disease, retransplant status, donor type, induction therapy, and length of follow-up until MPA monotherapy to determine outcomes between the groups.

Results: Of the 278 HLA-matched patients identified, 25 (9%) received MPA monotherapy and were matched to 25 recipients not on MPA monotherapy. Median time to MPA monotherapy from transplant was 7.8 years (range: 1.1-20.6 years). Two patients returned to calcineurin inhibitor based regimens secondary to membranous nephropathy and recurrence of post-transplant lymphoproliferative disorder. Recipients receiving MPA monotherapy experienced two deaths, one hospital admission, one infection, two malignancies, and no rejections or death-censored graft failures (p=not significant compared to control). However, MPA monotherapy was associated with a significantly lower rate of infection than in matched controls (1.6 vs 15.6 per 100 person-years; p=0.009, Figure 1).

Conclusions: Maintenance immunosuppression with MPA monotherapy is safe and effective for HLA-matched KTR. This approach may have the advantage of fewer infections. Randomized clinical trials are required to confirm these findings.

CITATION INFORMATION: Hennes A., Holdener K., Burlingham W., Astor B., Djamali A. Mycophenolate Monotherapy is Safe and Effective in HLA-Matched Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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