title: Progressive multifocal leukoencephalopathy and use of mycophenolate mofetil after kidney transplantation.
abstract: Mycophenolate mofetil (MMF) use may be associated with progressive multifocal leukoencephalopathy (PML). We conducted a retrospective cohort study of 32,757 renal transplant recipients using the United States Renal Data System kidney transplant files for the incidence, prognosis, and clinical features associated with PML occurring after kidney transplant. Subjects were transplanted from January 1, 2000 to July 31, 2004 and followed through December 31, 2004. The incidence density of PML in MMF users was 14.4 cases/100,000 person-years at risk versus 0 for non-MMF users (P=0.11) by log rank test. Factors significantly associated with PML were BK virus infection (22.2% vs. 1.1%), pretransplant transfusion (75% vs. 34%), panel reactive antibody more than 20% (56% vs. 14%), and use of antirejection medications in the first year (33% vs. 9.2%), all P less than 0.05. PML is rare in the renal transplant population. There was no significant association between PML and MMF, but MMF use in this cohort is too high to accurately assess an association.
authors.affiliation: Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. robert.neff@.amedd.army.mil
authors.forename: Robert T
authors.initials: RT
authors.lastname: Neff
authors.forename: Frank P
authors.initials: FP
authors.lastname: Hurst
authors.forename: Edward M
authors.initials: EM
authors.lastname: Falta
authors.forename: Erin M
authors.initials: EM
authors.lastname: Bohen
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.forename: Christina M
authors.initials: CM
authors.lastname: Yuan
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid