Clinical impact using low-dose mycophenolate mofetil with tacrolimus on infectious, noninfectious complications and acute rejection, in renal transplant: A single hospital experience in Mexico

• Published in: Medicine (Baltimore) Vol. 102; no. 46; p. e35841
• Main Authors: Andrade-Sierra, Jorge, Hernández-Reyes, Hernesto, Rojas-Campos, Enrique, Cardona-Muñoz, Ernesto Germán, Cerrillos-Gutiérrez, José Ignacio, González-Espinoza, Eduardo, Evangelista-Carrillo, Luis Alberto, Medina-Pérez, Miguel, Jalomo-Martínez, Basilio, Miranda-Díaz, Alejandra Guillermina, Martínez-Mejía, Víctor Manuel, Gómez-Navarro, Benjamin, Andrade-Ortega, Antonio de Jesús, Nieves-Hernández, Juan José, Mendoza-Cerpa, Claudia Alejandra
• Format: Journal Article
• Language: English
• Published: United States 17.11.2023
• Subjects: Communicable Diseases - etiology; Drug Therapy, Combination; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Graft Survival; Hospitals; Humans; Immunosuppressive Agents - adverse effects; Kidney Transplantation - adverse effects; Mexico - epidemiology; Mycophenolic Acid - adverse effects; Prospective Studies; Tacrolimus - adverse effects; Mexico
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000035841

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of <2 g could result in worse clinical outcomes in terms of acute rejection (AR). This study aimed to determine the association between AR and infectious and noninfectious complications after RT with a dose of 1.5 g vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan-Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.