Session Time: 6:00pm-7:00pm
Presentation Time: 6:05pm-6:10pm
*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 September 21, 2021.
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