title: A critical analysis of racial difference with mycophenolate mofetil (MMF) dosing, clinical outcomes and adverse effects in pediatric kidney transplant patients.
abstract: There is paucity in the data examining the differences in mycophenolate mofetil (MMF) dosing and outcomes among pediatric kidney transplant recipients (PKTX) between races. The aims of this study were as follows (i) to assess whether higher doses of MMF are being utilized in African American (AA) PKTX (ii) to determine whether there is a correlation between MMF dose and outcomes between races, and (iii) to assess the adverse effects of MMF between races. This study analyzed 109 PKTX who received MMF between 7/99 and 5/08. Demographics were similar between groups. Fewer AAs received kidneys from living donors (18% vs. 44%), spent more time on dialysis (1.0 vs. 0.5 yr), and had more human leukocyte antigen mismatches (4 vs. 3). MMF doses among AA patients were higher throughout the study, with statistical differences at week 4, month 3, and month 18. AA patients had significantly higher acute rejection rates and trended toward poorer graft survival; infections, adverse events from MMF and post-transplant lymphoproliferative disease tended to be lower in the AA patients. AA PKTX received higher MMF doses within the first three yr post-transplant compared to their non-AA counterparts, yet demonstrate significantly more acute rejection episodes. Importantly, MMF caused fewer adverse events in AA patients, despite these patients receiving higher doses.
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Jensen
authors.forename: S
authors.initials: S
authors.lastname: Shrivastava
authors.forename: D J
authors.initials: DJ
authors.lastname: Taber
authors.forename: N A
authors.initials: NA
authors.lastname: Weimert
authors.forename: I F
authors.initials: IF
authors.lastname: Shatat
authors.forename: J
authors.initials: J
authors.lastname: Orak
authors.forename: K D
authors.initials: KD
authors.lastname: Chavin
authors.forename: P K
authors.initials: PK
authors.lastname: Baliga
mesh_terms: D044383:Black People; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D001741:Black or African American
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid