Impact of mycophenolate mofetil intolerance on early results of kidney transplantation

Abstract

From 1992 to 2003, 407 kidney transplantations were performed on 403 patients using cyclosporine (CyA) or tacrolimus (Tac), mycophenolate (MMF), and steroid immunosuppression. Patient records examined for adverse events (AE) and MMF dose reductions or discontinuations during 100 days posttransplant were correlated with data on rejections, graft function, and survival. AEs occurred in 79.1% of transplantations. Gastrointestinal (GI) symptoms, infections, and cytopenias were common. Surprisingly, in 50% of all transplantations serum alanine transferase (ALAT) was elevated, among 21% the change was over three times the upper limit of normal. Patients with delayed graft function showed increased incidences of GI symptoms and thrombocytopenias. There were more ALAT increases and thrombocytopenias in patients on CyA and more GI symptoms in patients on Tac. In 34% of transplantations, the MMF dose was reduced or discontinued. In CyA patients with MMF reduction by day 21, rejection incidence during the subsequent 21 days was 10% versus 0.6% in patients with full-dose MMF until day 21 (P < .002). Among Tac patients no increased rejection frequency was seen after reducing MMF.