Evaluation of a Weight-Based Mycophenolate Mofetil Dosing Protocol for Kidney Transplant Maintenance Immunosuppression
1University Health, San Antonio, Department of Pharmacotherapy and Pharmacy Services, The University of Texas at Austin, Pharmacotherapy Division, College of Pharmacy, San Antonio, TX, 2University Transplant Center, University Health, San Antonio, Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
Meeting: 2021 American Transplant Congress
Abstract number: 274
Keywords: Adverse effects, Infection, Neutropenia, Rejection
Topic: Clinical Science » Kidney » Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Information
Session Name: Kidney Immunosuppression
Session Type: Rapid Fire Oral Abstract
Date: Monday, June 7, 2021
Session Time: 6:00pm-7:00pm
Presentation Time: 6:05pm-6:10pm
Location: Virtual
*Purpose: To evaluate the safety and efficacy of a weight-based mycophenolate mofetil (MMF) dosing protocol in adult kidney transplant recipients (KTR).
*Methods: This single-center retrospective study of adult KTR compared biopsy proven acute rejection (BPAR), any infections, hospitalizations, granulocyte colony-stimulating factor (G-CSF) use, and MMF dose changes within one year of transplant pre- and post-implementation of a weight-based MMF dosing protocol. Adult patients who received a kidney transplant at University Transplant Center between 12/15/16 and 12/1/19 were reviewed for inclusion. Patients in the weight-based MMF group received 1000 mg twice daily by first clinic visit if ≥ 80 kg, 750 mg twice daily if 50-79 kg, and 500 mg twice daily if < 50 kg. Patients in the fixed-dose MMF group received MMF 1000 mg twice daily. Goal tacrolimus trough was 8-12 ng/mL and prednisone was tapered to 5 mg PO daily by POD5.
Patients who received basiliximab induction immunosuppression, previous renal transplant, experienced delayed or slow graft function (defined by 24-hour urine output ≤500 mL by post-operative day 2), or were African American were excluded.
*Results: A total of 140 KTR (51% ≥ 80 kg, 45% 50-79 kg, 4% <50 kg) were included. Baseline characteristics were similar between groups. The majority of patients were middle-aged (median 50 years) Hispanic (62%) males (63%) and received rabbit anti-thymocyte globulin (57%). BPAR and infection rates were similar between both groups. The weight-based MMF group had fewer hospitalizations associated with non-infectious nausea, vomiting, or diarrhea (2.9% vs 12.9%; p = 0.03). Additional outcomes at 1 year are presented in Table 1.
*Conclusions: Weight-based MMF dosing was associated with fewer hospitalizations related to non-infectious GI adverse events compared to fixed-dose MMF. BAPR rates and other MMF-related adverse events assessed were similar between groups. Weight-based MMF dosing in standard immunologic risk adult KTR results in similar rates of BPAR and significantly fewer hospitalizations for non-infectious GI adverse events.
| Fixed-Dose MMF n (%) (n=70) | Weight-Based MMF Dose, n (%) (n=70) | p-value | |
| BPAR | 8 (11.4) | 10 (14.3) | 0.80 |
| Any Infection | 57 (81.4) | 61 (87.1) | 0.49 |
| G-CSF use | 19 (27.1) | 13 (18.6) | 0.31 |
| MMF dose change | 61 (87.1) | 55 (78.6) | 0.26 |
| Hospitalization associated with neutropenia | 3 (4.3) | 2 (2.9) | 1 |
| Hospitalization associated with any infection | 26 (37.1) | 27 (38.9) | 1 |
| Hospitalization associated with nausea, vomiting, or diarrhea | 9 (12.9) | 2 (2.9) | 0.03 |
To cite this abstract in AMA style:
Mahoney M, Kincaide E, Nelson J, Klein K, Hall R, Bhayana S. Evaluation of a Weight-Based Mycophenolate Mofetil Dosing Protocol for Kidney Transplant Maintenance Immunosuppression [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-a-weight-based-mycophenolate-mofetil-dosing-protocol-for-kidney-transplant-maintenance-immunosuppression/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress