Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study

Author:

Moudgil Asha1ORCID,Sgambat Kristen1ORCID,Benoit Elizabeth2,Seifert Michael E.3ORCID,Bharadwaj Madhumithaa4,Jain Amrish4,Mansuri Asif5,Harshman Lyndsay6,Katsoufis Chryso7,Somers Michael2

Affiliation:

1. Nephrology Children's National Hospital Washington DC USA

2. Nephrology Boston Children's Hospital Boston Massachusetts USA

3. Pediatric Nephrology The University of Alabama at Birmingham Birmingham Alabama USA

4. Pediatric Nephrology and Hypertension Children's Hospital of Michigan Detroit Michigan USA

5. Nephrology Children's Hospital of Georgia Augusta Georgia USA

6. Pediatric Nephrology University of Iowa Stead Family Children's Hospital Iowa City Iowa USA

7. Pediatric Nephrology Holtz Children's Hospital/Jackson Memorial Hospital Miami Florida USA

Abstract

AbstractBackgroundMycophenolate Mofetil (MMF) is an effective immunosuppressant used in kidney transplant recipients to prevent acute rejection. Complications such as diarrhea, leukopenia, and infections may necessitate the reduction or discontinuation of MMF. The objective of the study was to investigate the prevalence, timing, and reasons for MMF discontinuation and its association with outcomes in pediatric kidney transplant recipients.MethodsSeven Pediatric Nephrology Research Consortium (PNRC) centers participated in a retrospective analysis of kidney transplant recipients <21 years of age. Characteristics and outcomes of patients in whom MMF was discontinued were compared to those who continued taking MMF throughout the first 2 years post‐transplant.ResultsThe study population included 288 participants (mean age 11.2 years) from 7 North American transplant centers. MMF was discontinued in 93/288 (32%) of participants. Common reasons for discontinuation included infections (35%), diarrhea (32%), leukopenia (15%), and others (18%). Increased cumulative alloimmunity (55% vs. 42%, p = .02), increased number of hospitalizations (82% vs. 67%, p = .01), and viral replications (79% vs. 47%, p < .0001) were observed in the MMF discontinuation group compared to the continuation group. Greater eGFR decline also occurred in the MMF discontinuation group over 2 years of follow‐up (−7 vs. −1 mL/min/1.73 m2, p = .05).ConclusionsAlmost a third of pediatric kidney transplant recipients who begin MMF for maintenance immunosuppression have it discontinued within the first 2 years post‐transplant, and this subset of patients is more likely to experience adverse outcomes. New strategies are needed to manage MMF therapy and improve post‐transplant outcomes.

Publisher

Wiley

Subject

Transplantation,Pediatrics, Perinatology and Child Health

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