Session Date & Time: None. Available on demand.
*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 1st or 2nd 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 15, 2021.
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