A critical analysis of racial difference with mycophenolate mofetil (MMF) dosing, clinical outcomes and adverse effects in pediatric kidney transplant patients

• Published in: Clinical transplantation Vol. 25; no. 4; pp. 534 - 540
• Main Authors: Jensen, C.J., Shrivastava, S., Taber, D.J., Weimert, N.A., Shatat, I.F., Orak, J., Chavin, K.D., Baliga, P.K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Wiley
• Subjects: African American; African Continental Ancestry Group; Biological and medical sciences; Child; Cohort Studies; Cross-Sectional Studies; Dose-Response Relationship, Drug; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Graft Rejection; Humans; Immunosuppressive Agents - therapeutic use; Kidney Function Tests; Kidney Transplantation - ethnology; Kidney Transplantation - mortality; Male; Medical sciences; mycophenolate mofetil; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; pediatrics kidney transplant; Public health. Hygiene; Public health. Hygiene-occupational medicine; race; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Tissue, organ and graft immunology; Transplantation, Homologous; Treatment Outcome; Mofetil; Pediatrics; Mycophenolic acid; Prognosis; Toxicity; Homotransplantation; Epidemiology; Posology; Kidney; Surgery; Race; Secondary effect; Antiviral; Evolution; Child; Human; Ethnic origin; Enzyme; IMP dehydrogenase; Enzyme inhibitor; Ethnic group; Immunomodulator; Antibiotic; Treatment; pediatrics kidney transplant; Urinary system; Analysis; Oxidoreductases; Immunosuppressive agent; Mycophenolate mofetil; Inosine monophosphate dehydrogenase inhibitor; African American
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/j.1399-0012.2010.01304.x

Jensen CJ, Shrivastava S, Taber DJ, Weimert NA, Shatat IF, Orak J, Chavin KD, Baliga PK. A critical analysis of racial difference with mycophenolate mofetil (MMF) dosing, clinical outcomes and adverse effects in pediatric kidney transplant patients.
Clin Transplant 2011: 25: 534–540. © 2010 John Wiley & Sons A/S. :  There is paucity in the data examining the differences in mycophenolate mofetil (MMF) dosing and outcomes among pediatric kidney transplant recipients (PKTX) between races. The aims of this study were as follows (i) to assess whether higher doses of MMF are being utilized in African American (AA) PKTX (ii) to determine whether there is a correlation between MMF dose and outcomes between races, and (iii) to assess the adverse effects of MMF between races. This study analyzed 109 PKTX who received MMF between 7/99 and 5/08. Demographics were similar between groups. Fewer AAs received kidneys from living donors (18% vs. 44%), spent more time on dialysis (1.0 vs. 0.5 yr), and had more human leukocyte antigen mismatches (4 vs. 3). MMF doses among AA patients were higher throughout the study, with statistical differences at week 4, month 3, and month 18. AA patients had significantly higher acute rejection rates and trended toward poorer graft survival; infections, adverse events from MMF and post‐transplant lymphoproliferative disease tended to be lower in the AA patients. AA PKTX received higher MMF doses within the first three yr post‐transplant compared to their non‐AA counterparts, yet demonstrate significantly more acute rejection episodes. Importantly, MMF caused fewer adverse events in AA patients, despite these patients receiving higher doses.