Abstract: TH-PO751
Safety and Efficacy of Weight-Based MMF (Cellcept) Dosing in Kidney Transplant Recipients: A Quality Improvement Study
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Gangji, Aidan, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Hopman, Wilma M., Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Donelle, Jessy, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Felske, Melana, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Holland, David C., Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Shamseddin, M. Khaled, Kingston Health Sciences Centre, Kingston, Ontario, Canada
Background
Mycophenolate mofetil (MMF) reduces the risk of acute rejection (AR) in kidney transplant recipients (KTRs) and improves post-transplant graft survival. MMF is usually prescribed in fixed doses (2 gm/day). Due to its side effects, MMF doses often require reduction. Weight-based MMF dosing (10-16 mg/kg/day) was correlated with therapeutic level in Asian KTRs. We are aiming to evaluate the safety and efficacy of weight-based MMF dosing at 15 mg/kg/day, adopted by our program in September 2021.
Methods
This is a single center retrospective quality improvement study evaluating the safety and efficacy of weight-based MMF dosing at 15 mg/kg/day, compared with non-weight-based doses (≤ 2 gm/day), to reduce the risk of MMF-associated side effects including leukopenia (WBC ≤ 3.5), BK- and/or CMV-viremia, while monitoring the risk of AR associated with reduced MMF doses. All KTRs followed in our kidney transplant clinic at Queen’s University between September 1, 2021, and August 31, 2023, were included.
Results
230 KTRs [Age 56.9±14.4 years, Female (36.1%), Caucasian (87.8%)] were included. By August 31, 2023, 112 (48.7%) patients were on MMF. 18 patients were on weight-based doses (15.9 (14.9-18.1) mg/kg/day). 17 patients were on fixed doses (20.7 (17.2-26.2) mg/kg/day). 68.8% of MMF patients were on reduced doses (14.4 (10.4-14.4) mg/kg/day) due to adverse effects, most notably leukopenia (25%) and BK-viremia (18%). At the end of the study, leukopenia, BK- and CMV-viremia were active in 4 (1.7%), 7 (3%) and 1 (0.4%) of all patients, respectively and none of them were on weight-based MMF doses. Median eGFR of MMF patients was higher than non-MMF patients (58 vs. 53 ml/min per 1.73 sm; P 0.37), and it was better among patients on weight-based MMF doses compared with fixed (68.5 vs. 51; P 0.035) and reduced doses (58; P 0.26).
Conclusion
Snapshot data showed a low rate of leukopenia, BK- and CMV-viremia/infection, likely due to effective MMF dose reduction. Further analysis will be done through our next retrospective cohort study to evaluate the outcomes of weight-based dosing.
Funding
- Private Foundation Support