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. 2022 Aug 23:9:957299.
doi: 10.3389/fcvm.2022.957299. eCollection 2022.

Comparison of mid-term clinical outcome in heart transplantation patients using mycophenolate mofetil vs. enteric-coated mycophenolate sodium

Kina Jeon  1 , Darae Kim  1 , Jin-Oh Choi  1 , Yang Hyun Cho  2 , Kiick Sung  2 , Jaewon Oh  3 , Hyun Jai Cho  4 , Sung-Ho Jung  5 , Hae-Young Lee  4 , Jin Joo Park  6 , Dong-Ju Choi  6 , Seok-Min Kang  3 , Jae-Joong Kim  7 , Eun-Seok Jeon  1
Affiliations

Comparison of mid-term clinical outcome in heart transplantation patients using mycophenolate mofetil vs. enteric-coated mycophenolate sodium

Kina Jeon et al. Front Cardiovasc Med. .

Abstract

Background: Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid (MPA) and a key immunosuppressant for improving graft survival in patients with heart transplantation (HTx). However, dose reduction or interruption is occasionally needed due to gastrointestinal (GI) side effects. Enteric-coated mycophenolate sodium (EC-MPS) is an alternative form of MPA delivery to improve GI tolerability. In the present study, the efficacy of EC-MPS compared with MMF in HTx patients was investigated.

Methods: In this retrospective study, the Korean Organ Transplant Registry (KOTRY) data were used to analyze the efficacy and rejection rate of MMF and EC-MPS. A total of 611 patients was enrolled from 2014 to February of 2021. Patients were divided based on the use of MMF or EC-MPS at 6 months post-HTx. Patients who were not prescribed MMF or EC-MPS were excluded. Graft survival, all-cause mortality, and treated rejection were compared between the two groups. All statistical analyses were performed using SPSS; characteristics were compared using Pearson chi-square test and survival rate with Kaplan-Meier plot and log-rank test.

Results: A total of 510 HTx patients was analyzed (mean age: 51.74 ± 13.16 years, males: 68.2%). At 6 months after HTx, 78 patients were taking EC-MPA (12.8%) and 432 patients were taking MMF (70.7%). The median follow-up was 42.0 months (IQR: 21.7-61.0 months). Post-HTx outcomes including overall survival, all cause mortality, acute cell mediated rejection (ACR), acute antibody mediated rejection (AMR), treated rejection, and cardiac allograft vasculopathy (CAV) were comparable between the two groups during follow-up.

Conclusion: Notable differences were not observed in overall survival, all cause mortality, ACR, AMR, treated rejection, and CAV between MMF and EC-MPS groups. Efficacy of EC-MPS was similar to that of MMF in HTx patients during mid-term follow up after HTx.

Keywords: heart transplantation; mycophenolate mofetil; mycophenolic acid; prognosis; rejection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Comparison of overall survival between HTx patients in EC-MPS and MMF groups. (B) Cumulative survival in freedom from treated rejection in heart transplantation patients using MMF vs. EC-MPS. Overall survival rates (A) and cumulative survival in freedom from treated rejection (B) were similar between HTx patients in the EC-MPS and MMF groups. HTx, heart transplantation; EC-MPS, enteric-coated mycophenolate sodium; MMF, mycophenolate mofetil.
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