title: Increased incidence of infections following the late introduction of mycophenolate mofetil in renal transplant recipients.
abstract: BACKGROUND
  Late introduction of mycophenolate mofetil (MMF) is used in renal transplant patients to allow calcineurin inhibitor (CNI) withdrawal. This change in treatment may alter the immunosuppressive load predisposing patients to infections. To assess this we have analysed infection rates in 30 consecutive patients with chronic allograft nephropathy commenced on MMF for CNI withdrawal. Methods and results. The study period was from 12 months pre-commencement to 12 months post-commencement. At commencement, patient mean age was 51.2 +/- 12.9 years and mean time post-transplant was 3170 +/- 2130 days. Estimated glomerular filtration rate (eGFR) at the start of the study period and at conversion was 30.7 +/- 12.1 ml/min and 23.1 +/- 9.9 ml/min, respectively. The mean dose of MMF post-conversion was 1575 +/- 428 mg/day. Estimated GFR had stabilized at 12 months post-conversion to 25.3 +/- 12.2 ml/min. There was a significant increase in infections following conversion: pre-conversion, 26.7% (8/30); post-conversion, 66.6% (20/30) (chi(2) = 24.5, P < 0.0005). There was an inverse correlation between eGFR at conversion and infection rates post-conversion (r = -0.379, P = 0.039). There were no hospitalizations for infection pre-conversion and 6 patients (20%) were hospitalized post-conversion, for a total of 285 days (7-107).
  
  
  CONCLUSIONS
  There is significant morbidity associated with an increased incidence of infection after late introduction of MMF at standard doses in renal transplant recipients. This risk may be related to GFR at the time of conversion.
authors.affiliation: Department of Nephrology and Renal Transplantation, University Hospital Birmingham, Edgbaston, Birmingham, UK. rhanvesakul@doctors.org.uk
authors.forename: Rajesh
authors.initials: R
authors.lastname: Hanvesakul
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Kubal
authors.forename: Seema
authors.initials: S
authors.lastname: Jham
authors.forename: Esha
authors.initials: E
authors.lastname: Sarkar
authors.forename: Kevin
authors.initials: K
authors.lastname: Eardley
authors.forename: Dwomoa
authors.initials: D
authors.lastname: Adu
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007239:Infections / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid