title: Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome.
abstract: Mycophenolate mofetil (MMF) decreases the risk of acute rejection and is associated with improved graft survival in renal transplant recipients. However, MMF-related side effects often necessitate dose reduction, which may expose patients to a higher risk of acute rejection and graft loss. This study's aim was to examine the reasons for MMF dose reduction during the first post-transplant year and its impact on acute rejection, overall and death-censored graft loss.
  
  
  METHODS
  Single-center retrospective analysis of 749 renal transplant recipients treated with MMF in their initial maintenance immunosuppressive protocol.
  
  
  RESULTS
  In 365 patients (48.7%) a total of 530 MMF dose reductions were done. Reasons for reduction were hematologic toxicity (46.5%), infection (16.1%), gastrointestinal side effects (12.3%), malignancy (2.1%), study protocol (14.6%), and unknown (13.5%). MMF dose reduction as such was not an independent predictor of acute rejection or graft survival, although reductions in ≥ 50% of initial dose were significantly associated with acute rejection.
  
  
  CONCLUSIONS
  In this retrospective cohort, by far the most important reason for MMF dose reduction during the first post-transplantation year was hematologic. MMF dose reductions in ≥ 50% increased the risk of acute rejection but did not compromise graft survival.
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanhove
authors.forename: Dirk
authors.initials: D
authors.lastname: Kuypers
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Claes
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.forename: Björn
authors.initials: B
authors.lastname: Meijers
authors.forename: Maarten
authors.initials: M
authors.lastname: Naesens
authors.forename: Yves
authors.initials: Y
authors.lastname: Vanrenterghem
authors.forename: Tom
authors.initials: T
authors.lastname: Cornelis
authors.forename: Bert
authors.initials: B
authors.lastname: Bammens
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000401:mortality; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010198:Pancytopenia / Q000139:chemically induced; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: acute rejection; adverse event; dose reduction; graft loss; mycophenolate mofetil; renal transplantation