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Tolerability of mycophenolate mofetil in elderly kidney transplant recipients: A retrospective cohort study
Stephanie Witek1, Gregory Malat1,2, Deirdre Sawinski2,3
1Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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.
Insights
Elderly kidney transplant recipients (KTRs) experienced higher mycophenolate mofetil (MMF) dose reductions, often due to leukopenia. Despite this, no short-term negative impacts on graft survival or function were observed in either elderly or nonelderly KTRs.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Optimal immunosuppression for elderly kidney transplant recipients (KTRs) remains unclear.
- Mycophenolate mofetil (MMF) is often poorly tolerated in this population.
Purpose of the Study:
- To compare the incidence and reasons for MMF dose reduction in elderly versus nonelderly KTRs within the first year post-transplant.
- To evaluate MMF 1 g/day tolerability in KTRs receiving lymphocyte-depleting induction therapy.
Main Methods:
- A single-center retrospective study of 335 KTRs receiving rabbit antithymocyte globulin (rATG), MMF, tacrolimus, and prednisone.
- KTRs were stratified into elderly (≥60 years) and nonelderly (<60 years) groups.
- Primary outcome was MMF dose reduction incidence; secondary outcomes included reasons for reduction, patient/graft survival, graft function, rejection, and infection rates.
Main Results:
- The incidence of MMF dose reduction was higher in the elderly group (66%) compared to the nonelderly group (54%), although not statistically significant after adjustment.
- Leukopenia was the primary reason for dose reduction in the elderly, while cytomegalovirus (CMV) infection was more common in the nonelderly group.
- No significant differences were observed in 1-year patient survival, graft survival, graft function, rejection, or infection rates between the groups.
Conclusions:
- Mycophenolate mofetil 1 g/day was poorly tolerated in both elderly and nonelderly KTRs, leading to frequent dose reductions.
- Despite higher MMF dose reduction rates in the elderly, no short-term adverse outcomes for graft survival or function were identified.
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