Tolerability of mycophenolate mofetil in elderly kidney transplant recipients: A retrospective cohort study

Abstract

Background: Optimal immunosuppression in elderly kidney transplant recipients (KTRs) is not well defined, with mycophenolate mofetil (MMF) being poorly tolerated.Study aim was to compare MMF dose reduction incidence and reason(s) in elderly vs.nonelderly KTRs in the 1st year after transplant with a protocol dose of 1 g/day.Methods: In this single-center retrospective study, first or repeat KTRs receiving rabbit antithymocyte globulin (rATG), MMF 1 g/day, tacrolimus, and prednisone, were stratified by age [≥60 (elderly) or <60 years (nonelderly)]. Primary outcome was MMF dose reduction incidence in the first year. Secondary outcomes included dose reduction rationale, 1-year patient and graft survival, graft function, rejection, infection, hospital presentation, and time to dose reduction. Of 335 KTRs, dose reduction incidence was significantly greater in the elderly group (66% and 54%, p = 0.04), though this did not remain significant when adjusted for sex, race, and valganciclovir use. Most common rationale was leukopenia in the elderly group and CMV in the nonelderly group.There were no significant differences in secondary outcomes. Conclusions:Mycophenolate mofetil 1 g/day was poorly tolerated in both elderly and nonelderly KTRs receiving lymphocyte-depleting induction with a high incidence of dose reductions; however, no short-term adverse graft outcomes were identified.

Clinical impact using low-dose mycophenolate mofetil with tacrolimus on infectious, noninfectious complications and acute rejection, in renal transplant: A single hospital experience in Mexico

“…A special population is the elderly patients, because low doses of MMF (1 g/day) are even poorly tolerated when receiving thymoglobulin induction with a high incidence of dose reductions; Witek S et al, using 1 g of MMF with subsequent reductions, did not show differences in graft function, rejection, and 1-year patient and graft survival, compared with non-elderly. [24] In our case, the population studied was young, but the lower dose group did not require a greater reduction, despite the fact that those with standard doses experienced a significant reduction in MMF doses; however, none were lower than 1.5 g in either group. When using a dose of < 1.5g or withdrawing MMF, there is a risk of AR.…”

Individualization of Mycophenolic Acid Therapy through Pharmacogenetic, Pharmacokinetic and Pharmacodynamic Testing

“…Whereas some patients are complete non-responders, others require higher doses of MPA to respond appropriately. Likewise, some patients have more side effects and dose reductions are needed more frequently [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Mycophenolic acid therapy is currently administered to all adult transplant patients at standard dosages according to the manufacturer’s guidelines.…”