Journal article
Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study
Pediatric transplantation, Vol.28(1), e14628
02/2024
DOI: 10.1111/petr.14628
PMID: 37877312
Abstract
BACKGROUNDMycophenolate 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.
Details
- Title: Subtitle
- Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study
- Creators
- Asha Moudgil - Children's NationalKristen Sgambat - Children's NationalElizabeth Benoit - Boston Children's HospitalMichael E Seifert - Pediatric Nephrology of AlabamaMadhumithaa Bharadwaj - Children's Hospital of MichiganAmrish Jain - Children's Hospital of MichiganAsif Mansuri - Augusta UniversityLyndsay Harshman - University of IowaChryso Katsoufis - Jackson Memorial HospitalMichael Somers - Boston Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Pediatric transplantation, Vol.28(1), e14628
- DOI
- 10.1111/petr.14628
- PMID
- 37877312
- NLM abbreviation
- Pediatr Transplant
- eISSN
- 1399-3046
- Language
- English
- Electronic publication date
- 10/25/2023
- Date published
- 02/2024
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Radiation Oncology
- Record Identifier
- 9984500080402771
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