2010 - TTS International Congress
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Clinical Immunosuppression Kidney late
19.25 - Mycophenolic Acid (MPA) Dose Reductions Result in Poor Long Term Renal Allograft Survival: Comparison Between Sodium Mycophenolate (SMPA) and Mycophenolate Mofetil (MMF)
Presenter: Mark Reza, Laftavi, Buffalo, United States
Authors: Laftavi M., Hai F., Laftavi H., Feng L., Said M., Alnimri M., Kohli R., Patel S., Pankewycz O.
CLINICAL IMMUNOSUPPRESSION - KIDNEY LATE
M.R. Laftavi1, F. Hai2, H. Laftavi2, L. Feng2, M. Said2, M. Alnimri2, R. Kohli3, S.K. Patel2, O. Pankewycz2
1Surgery, SUNY at Buffalo, Buffalo/UNITED STATES OF AMERICA, 2Surgery, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA, 3Medicine, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA
Body: MPA therapy is associated with a decrease in acute rejection rates and excellent renal allograft survival. Unfortunately, MMF is associated with significant adverse effects (AEs) which, in many cases, preclude full-dose therapy. Patients who had a >50% dose reduction of MMF experienced a lower graft survival and higher rejection rates compared to those who tolerated the full dose MMF. SMPA was designed to improve the MPA-associated GI AEs profile. In this retrospective study, we studied the tolerability and long-term outcomes in renal transplant recipients (RTR) treated with SMPA versus MMF. 449 RTR who received SMPA or MMF for more than 3 months were classified into three groups: Gr.1 initially treated with MMF, Gr.2 initially treated with SMPA and Gr.3 those who switched from MMF to SMPA due to AEs. Donor and recipient demographics, induction and maintenance immunosuppressive therapies were similar in all groups. Patient survival was similar in all groups. However, long-term graft survival was lower in patients whose dose of either SMPA or MMF was reduced by >50% (Fig.1). Moreover, a >50% dose reduction was associated with a higher rate of rejection (38%) compared to full-dose (21%, p<0.01). Fewer patients treated with SMPA (Gr.2) required dose reductions (29%) vs. MMF (35%) (Gr.1) (Table1). Furthermore, 38% of patients in Gr.3 tolerated full-dose SMPA despite previous intolerance to MMF (Table1). Finally, the long-term graft survival was best in initially SMPA treated RTR and worst in Gr.3, those who switched due to AEs (Fig.2). We conclude that SMPA is better tolerated than MMF which may explain the superior graft outcome in RTR who were treated with SMPA from the onset.
| Groups | Tolerate Full Dose | Dose Reduced ≥50% | Drug Discontinued | Rejection Rate | SCr. @ 1y±SD | SCr. @ 3y±SD |
| Gr.1 (n=242) | 35% | 35%* | 7.4% | 24% | 1.5±0.7 | 1.5±0.5 |
| Gr.2 (n=127) | 58%* | 29% | 4.7% | 17% | 1.4±0.4 | 1.5±0.5 |
| Gr.3 (n=80) | 38% | 37%* | 6.2% | 40%* | 1.5±0.5 | 1.7±0.7 |
Table 1: *p<0.05
Fig. 1 
Fig. 2Disclosure: All authors have declared no conflicts of interest.
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