Tolerability of Mycophenolate Mofetil in Elderly Kidney Transplant Recipients: A Retrospective Cohort Study

S. Witek¹, G. Malat², D. Sawinski², C. Sammons², C. LaFratte¹, A. Forte¹, R. Samudralwar¹, S. Lyle¹, J. Rashid¹, J. Trofe-Clark²

¹Dept of Pharmacy, Hospital of the Univ of Pennsylvania, Philadelphia, PA, ²Penn Transplant Institute, Hospital of the Univ of Pennsylvania, Philadelphia, PA

Meeting: 2021 American Transplant Congress

Abstract number: 945

Keywords: Elderly patients, Infection, Kidney transplantation, Mycophenolate mofetil

Topic: Clinical Science » Kidney » Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Information

Session Name: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Optimal immunosuppression in elderly kidney transplant recipients (KTRs) is not well-defined, with MMF being poorly tolerated at standard doses. This study aims to compare MMF dose reduction incidence and reason(s) in elderly vs. non-elderly KTRs in the first yr after transplant with a protocol dose of 1g/day.

*Methods: In this IRB-approved, single-center retrospective cohort study, KTRs receiving rabbit antithymocyte globulin (rATG) induction, MMF 1g/day, tacrolimus, and prednisone, with ≥ 6 mos f/u were stratified by age [≥ 60 (elderly) or < 60 yrs (non-elderly)]. Only 1^st or 2^nd KTRs alone were considered. Primary outcome was MMF dose reduction incidence in the first yr, reviewed at defined intervals. Secondary outcomes include the indication for dose reduction, 1-yr patient/graft survival, and graft function.

*Results: An interim analysis included 133 KTRs (elderly n=51, non-elderly n=82). Groups were similar in demographics except for more living donors and lower kidney donor profile index (KDPI) in the non-elderly group (Table 1). MMF dose reductions occurred in 32 elderly and 50 non-elderly KTRs during the first yr (61% vs 63%, p=0.86) for reasons mentioned in Table 2. Most dose reductions occurred within 2 mos (elderly 31% vs. non-elderly 32%) with nearly all occurring between mos 2-6 (84% and 82%). At 1 yr, 47% elderly and 49% non-elderly were on MMF 1g/day (p=0.86), 6% and 13% were on 500mg/day (p=0.25), and 45% and 35% were on 0mg/day (p=0.28). There were no differences in 1-yr patient/graft survival or graft function.

*Conclusions: In this interim analysis, there was no difference in MMF dose reduction incidence between elderly vs non-elderly KTRs using 1g/day with rATG induction. Most dose reductions occurred in the first 6 mos post-transplant. The elderly KTR group more commonly required MMF dose reductions secondary to GI side effects and viral infections, including BK and CMV, although not statistically significant. Continued data collection/analysis is necessary to further elucidate this trend.

To cite this abstract in AMA style:

Witek S, Malat G, Sawinski D, Sammons C, LaFratte C, Forte A, Samudralwar R, Lyle S, Rashid J, Trofe-Clark J. Tolerability of Mycophenolate Mofetil in Elderly Kidney Transplant Recipients: A Retrospective Cohort Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/tolerability-of-mycophenolate-mofetil-in-elderly-kidney-transplant-recipients-a-retrospective-cohort-study/. Accessed June 23, 2025.

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