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Title: | Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function. | Authors: | Polkinghorne K.R. ;Mulley W.R.;Kanellis J.;Leong K.G.;Dave V. | Monash Health Department(s): | Nephrology | Institution: | (Dave, Polkinghorne, Leong, Kanellis, Mulley) Department of Nephrology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia (Polkinghorne, Leong, Kanellis, Mulley) Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, VIC, 3168, Australia (Polkinghorne) Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia | Issue Date: | 24-Mar-2021 | Copyright year: | 2020 | Publisher: | NLM (Medline) | Place of publication: | United Kingdom | Publication information: | Scientific reports. 10 (1) (pp 19379), 2020. Date of Publication: 09 Nov 2020. | Journal: | Scientific Reports | Abstract: | The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients. | DOI: | http://monash.idm.oclc.org/login?url= http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1038/s41598-020-76379-6 |
PubMed URL: | 33168923 [http://www.ncbi.nlm.nih.gov/pubmed/?term=33168923] | ISSN: | 2045-2322 (electronic) | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/26890 | Type: | Article | Subjects: | follow up *graft rejection/ep [Epidemiology] *graft rejection/pc [Prevention] human *kidney transplantation *leukopenia male middle aged pregnancy retrospective study time factor adult mycophenolic acid/ae [Adverse Drug Reaction] tacrolimus/ad [Drug Administration] tacrolimus/ae [Adverse Drug Reaction] comparative study mycophenolic acid/ad [Drug Administration] enzymology female retrospective study time factor middle aged male *leukopenia *kidney transplantation human *graft rejection / *epidemiology / *prevention adult enzymology comparative study pregnancy follow up female |
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