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Impact of mycophenolate mofetil dose posttransplantation on 12-month renal function: analysis of the MOST database
M Salvadori1, A Bock, J Chapman
1U.O. di Nefrologia dei Trapianti, Policlinico di Careggi, Firenze, Italia. salvadorim@ao-careggi.toscana.it
Introduction:
Mycophenolate mofetil (MMF) has greatly reduced the risk of acute rejection episodes (ARE) after renal transplantation, but dose reductions/withdrawals could jeopardize long-term results.
Methods:
The MOST database of "de novo" patients treated with MMF at month 1 and functioning grafts at month 12 were divided into 2 groups: groups 1, 2 g MMF at month 1 and month 12; and group 2, 2 g MMF at month 1 but MMF <2 g at month 12 to evaluate renal function glonerular filtration rate (GFR).
Results:
In this study, 1136 patients were receiving 2 g MMF at month 1. On month 12, 645 were on 2 g (56.8%, group 1) and 431 were on <2 g (43.2%, group 2). Group 1 included younger recipients of younger donors with fewer patients with delayed graft function (DGF). Group 1 showed more ARE during month 1 and more patients who received induction. Mean Neoral daily doses at month 1/month 12 were 5.3/3.0 and 5.3/3.1 mg/kg in group 1 and group 2, respectively (P = .05 at month 12). GFR in group 1 and group 2 were 59.06 (CI 57.10-60.60) and 53.81 (CI 52-55.7) at month 1 (P < .001); 63.7 (CI 62.1-65.30) and 55.9 (CI 54.1-57.7) mL/min*1.73 m(2) at month 12 (P < .001). The mean increases in GFR between month 1 and month 12 were 4.64 and 1.94 mL/min*1.73 m(2), respectively (P < .05). A multivariate analysis also included 795 patients from the "maintenance" patient database with retrospective detailed information. The following parameters were highly predictive for good renal function at month 12: donor age younger than 60 years, recipient age younger than 60 years, immediate graft function, 12-month MMF dose = 2 g, absence of CMV infection, and 12-month Neoral dose <3 mg/kg/d.
Conclusions:
Maintenance of MMF dose at 2 g/d during the first year appears to facilitate the attainment of optimal renal function at 12-months after kidney transplantation.
Insights
Maintaining a 2 g daily dose of mycophenolate mofetil (MMF) in the first year after kidney transplant improves long-term renal function. Reduced MMF doses were associated with lower glomerular filtration rates (GFR).
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation Medicine
Background:
- Mycophenolate mofetil (MMF) is crucial for reducing acute rejection episodes (ARE) post-renal transplant.
- However, MMF dose reduction or withdrawal may compromise long-term graft outcomes.
Purpose of the Study:
- To evaluate the impact of MMF dosage maintenance on renal function at 12 months post-kidney transplantation.
- To identify factors predictive of optimal renal function at 12 months.
Main Methods:
- Retrospective analysis of the MOST database including 1136 de novo kidney transplant patients.
- Patients were divided into two groups: Group 1 (2g MMF at months 1 and 12) and Group 2 (2g MMF at month 1, <2g at month 12).
- Glomerular filtration rate (GFR) was assessed at 1 and 12 months. Multivariate analysis included 795 patients.
Main Results:
- Group 1 (maintained 2g MMF) showed significantly higher GFR at 1 and 12 months compared to Group 2 (reduced MMF).
- Mean GFR increase from month 1 to 12 was greater in Group 1 (4.64 mL/min/1.73 m²) than in Group 2 (1.94 mL/min/1.73 m²).
- Predictive factors for good 12-month renal function included younger donor/recipient age, immediate graft function, 12-month MMF dose of 2g, no CMV infection, and lower Neoral dose.
Conclusions:
- Maintaining a 2g daily MMF dose throughout the first year post-transplant is associated with optimal renal function at 12 months.
- This dosage strategy appears to facilitate better long-term graft outcomes.
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