Mycophenolate Mofetil Dose Reduction for Gastrointestinal Intolerance is Associated With Increased Rates of Rejection in Heart Transplant Patients

Galiwango, Paul; Delgado, Diego; Yan, Raymond T.; Kozuszko, Stella; Smith, Robert; Rao, Vivek; Ross, Heather J.

doi:10.1016/j.healun.2007.10.012

Cited by 31 publications

(20 citation statements)

References 18 publications

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“…5,8,27,28 Renal and liver function were preserved in our patients and did not differ between the two measurement time-points. Thirty-three percent of the patients were on a maintenance dose of low-dose steroids (0.1 mg/kg prednisolone) and had the same prednisolone dose at both time-points.…”

Section: Discussionmentioning

confidence: 51%

The proton pump inhibitor pantoprazole and its interaction with enteric-coated mycophenolate sodium in transplant recipients

Kofler

Wolf

Shvets

et al. 2011

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 51%

The proton pump inhibitor pantoprazole and its interaction with enteric-coated mycophenolate sodium in transplant recipients

Kofler

Wolf

Shvets

et al. 2011

The Journal of Heart and Lung Transplantation

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“…The latter were more often dictated by a clinical trial protocol. Several studies analyzing the indications for MMF dose reduction have reported a similar distribution ; others found GI side effects to be the most important reason, motivating 29.4–46.5% of dose reductions .…”

Section: Discussionmentioning

confidence: 85%

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

Vanhove

Claes²,

Evenepoel³

et al. 2013

Transpl Int

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Summary Mycophenolate mofetil (MMF) decreases the risk of acute rejection and is associated with improved graft survival in renal transplant recipients. However, MMF‐related side effects often necessitate dose reduction, which may expose patients to a higher risk of acute rejection and graft loss. This study's aim was to examine the reasons for MMF dose reduction during the first post‐transplant year and its impact on acute rejection, overall and death‐censored graft loss. Methods: Single‐center retrospective analysis of 749 renal transplant recipients treated with MMF in their initial maintenance immunosuppressive protocol. Results: In 365 patients (48.7%) a total of 530 MMF dose reductions were done. Reasons for reduction were hematologic toxicity (46.5%), infection (16.1%), gastrointestinal side effects (12.3%), malignancy (2.1%), study protocol (14.6%), and unknown (13.5%). MMF dose reduction as such was not an independent predictor of acute rejection or graft survival, although reductions in ≥50% of initial dose were significantly associated with acute rejection. Conclusions: In this retrospective cohort, by far the most important reason for MMF dose reduction during the first post‐transplantation year was hematologic. MMF dose reductions in ≥50% increased the risk of acute rejection but did not compromise graft survival.

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“…Galiwango et al showed that MMF dose reduction (for gastrointestinal intolerance) was associated with a significantly increased rate of sustained rejection in heart transplant patients. 36 Kaczmarek et al and Meiser et al found that lower therapeutic drug concentrations of MMF correlate not only with increased rates of acute rejection but also with development of TVP. 37,38 Eisen et al presented results of MMF vs azathioprine (AZA), showing a reduced mortality and graft loss up to 3 years after heart transplantation.…”

Section: Discussionmentioning

confidence: 97%

Proton Pump Inhibitor Co-medication Reduces Mycophenolate Acid Drug Exposure in Heart Transplant Recipients

Kofler

Deutsch

Bigdeli

et al. 2009

The Journal of Heart and Lung Transplantation

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Mycophenolate Mofetil Dose Reduction for Gastrointestinal Intolerance is Associated With Increased Rates of Rejection in Heart Transplant Patients

Cited by 31 publications

References 18 publications

The proton pump inhibitor pantoprazole and its interaction with enteric-coated mycophenolate sodium in transplant recipients

The proton pump inhibitor pantoprazole and its interaction with enteric-coated mycophenolate sodium in transplant recipients

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

Proton Pump Inhibitor Co-medication Reduces Mycophenolate Acid Drug Exposure in Heart Transplant Recipients

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