2010 - TTS International Congress


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Clinical Immunosuppression Kidney early

22.29 - Routine reduction in mycophenolate mofetil from 1g twice daily to 0.5g twice daily after the first 30 days does not compromise short term outcome.

Presenter: Andrew, Watts, London,
Authors: Watts A., Andrews P., Fronek J., Kessaris N., Kingdon E., Morsy M., Popoola J., MacPhee I.

ROUTINE REDUCTION IN MYCOPHENOLATE MOFETIL FROM 1G TWICE DAILY TO 0.5G TWICE DAILY AFTER THE FIRST 30 DAYS DOES NOT COMPROMISE SHORT TERM OUTCOME.

CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

A.J.B. Watts1, P. Andrews2, J. Fronek1, N. Kessaris1, E. Kingdon3, M. Morsy1, J. Popoola1, I.A.M. Macphee4
1Renal Medicine And Transplantation, St Georges Hospital, London/UNITED KINGDOM, 2, St Helier Hospital, Surrey/UNITED KINGDOM, 3, Sussex Kidney Unit, Brighton/UNITED KINGDOM, 4Cellular And Molecular Medicine: Renal Medicine, St. George's, University of London, London/UNITED KINGDOM

Body: Introduction The FDDC study (van Gelder, et al 2008;86:1043) suggested that higher doses of mycophenolate mofetil (MMF) are required during the first month after renal transplantation (2g daily) to achieve optimal exposure but this may then be lowered to 1-1.5g/day thereafter. Methods In May 2007 the protocol was changed to use 1g MMF twice daily for the first 30 days after renal transplantation with a subsequent dose reduction to 0.5g twice daily. Patients also received Tacrolimus to a target trough blood concentration of 8-15ng/mL (30days) followed by 8-12ng/mL (up to 90days), together with either long term or rapidly tapered prednisolone for those considered to be high risk of NODAT (29 out of 120 (24%)). All patients were treated with basiliximab at the time of transplantation. Results There were a total of 120 patients included. Just over half of transplants, 53% were from live donors, with 28% heart beating deceased donors and 18% non-heart beating deceased donors. The majority were first transplants with only 11% being either a 2nd or 3rd transplant. The median HLA A,B,DR mismatch was 3. There were a total of 12 biopsy confirmed acute rejection episodes of at least Banff grade 1 within the first 90 days post transplant (10% acute rejection rate). Conclusion Planning MMF dosing based on the predicted exposure from the FDCC study of 2g daily for the first 30 days followed by 1g daily thereafter delivered excellent efficacy and was well tolerated.

Disclosure: All authors have declared no conflicts of interest.


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