Kidney Week

Abstract: SA-PO010

Clinical Outcomes and Factors Related with Mycophenolate Mofetil Withdrawal in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Park, Woo Yeong, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Woo Yeong Park,

• Park, Hayeon, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Hayeon Park,

• Paek, Jin hyuk, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Jin hyuk Paek,

• Jin, Kyubok, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Kyubok Jin,

• Han, Seungyeup, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Seungyeup Han,

Background

Although the most effective initial maintenance immunosuppressants in kidney transplantation (KT) have been known as a combination of calcineurin inhibitor (CNI), steroid, and mycophenolate mofetil (MMF), immunosuppressive regimen has been changed due to several reasons within 1-year after KT. The most common changing pattern was MMF withdrawal, but the clinical course of the kidney transplant recipients (KTRs) after MMF withdrawal was not known clearly. The purpose of this study is to investigate the causes of MMF withdrawal, and the clinical outcomes and factors related with MMF withdrawal in KTRs.

Methods

We retrospectively analyzed the medical records of 626 KTRs performed KT at Dongsan Medical Center between 2000 and 2016. We evaluated the incidence of acute rejection, allograft and patient survival rates, and factors related with MMF withdrawal.

Results

Mean age of KTRs was 44.1 ± 11.6 years. Median time between KT and MMF withdrawal was 6.4 (range, 3.2 – 32.1) months. The most common cause of MMF withdrawal was infection (70.7%), followed by hematologic abnormalities (9.1%), and gastrointestinal trouble (7.7%). The proportion of cytomegalovirus infection was the highest (60.5%) among all infections, followed by BK virus infection (18.4%). The proportion of female KTRs and the incidence of BPAR were significantly higher in the MMF withdrawal arm compared with the non-MMF withdrawal arm (57.7% vs. 34.4%, P < 0.001; 27.4% vs. 8.9%, P < 0.001). Death-censored graft survival and patient survival rates were significantly lower in the MMF withdrawal arm compared with the non-MMF withdrawal arm (P < 0.001; P < 0.001). In multivariate analysis, MMF withdrawal was an independent risk factor for graft failure after adjustment for recipient age, gender, infection, and deceased donor KT (HR 6.058, 95% C.I., 3.172-11.569, P < 0.001).

Conclusion

The incidence of acute rejection, graft failure, and patient mortality rates in KT were high after MMF withdrawal. Therefore, MMF withdrawal should be considered carefully and resumed as soon as possible.