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Long-term outcome of gastrointestinal complications in renal transplant patients treated with mycophenolate mofetil

  • Original Article
  • Published:
Transplant International

Abstract

This study examined consequences of gastrointestinal (GI) complications and mycophenolate mofetil (MMF) discontinuation on long-term outcomes in patients who received MMF at transplantation and had graft function 12 months post-transplantation. Data were obtained from the United States Renal Data System for cadaveric renal transplant recipients between 1995 and 1998. GI complications or MMF discontinuation occurred in 27.4% and 17.5% of patients, respectively. MMF was discontinued in 21.3% of patients with GI complications and 16.0% of patients without (P<0.00001). Four-year graft survival was reduced from 87.1% to 82.3% (P=0.091) with MMF discontinuation, to 83.0% (P=0.001) with GI complications, and to 70.2% (P<0.0001) with GI complications and MMF discontinuation. While the retrospective nature of this work cannot prove causality, which will require future prospective studies, both GI complications and MMF withdrawal are associated with increased risk of graft loss and may warrant further study in the management of transplant recipients.

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References

  1. Helderman JH. Prophylaxis and treatment of gastrointestinal complications following transplantation. Clin Transplant 2001; 15:29.

    PubMed  Google Scholar 

  2. Rubin RH. Gastrointestinal infectious disease complications following transplantation and their differentiation from immunosuppressant-induced gastrointestinal toxicities. Clin Transplant 2001; 15:11.

    Google Scholar 

  3. Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Soc Nephrol 2002; 13:277.

    PubMed  Google Scholar 

  4. Mele TS, Halloran PF. The use of mycophenolate mofetil in transplant recipients. Immunopharmacology 2000; 47:215.

    Article  CAS  PubMed  Google Scholar 

  5. Behrend M. Adverse gastrointestinal effects of mycophenolate mofetil. Aetiology, incidence and management. Drug Saf 2001; 24:645.

    CAS  PubMed  Google Scholar 

  6. Sollinger HW, for the US Renal Transplant Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. Transplantation 1995; 60:225.

    CAS  PubMed  Google Scholar 

  7. European Mycophenolate Mofetil Study Group. Placebo-controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection. Lancet 1995; 345:1321.

    PubMed  Google Scholar 

  8. The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection on cadaveric renal transplantation. Transplantation 1996; 61:1029.

    PubMed  Google Scholar 

  9. Pescovitz MD, Navarro MT. Immunosuppressive therapy and post-transplantation diarrhea. Clin Transplant 2001; 15:23.

    PubMed  Google Scholar 

  10. Pelletier RP, Akin B, Henry ML, et al. The impact of mycophenolate mofetil dosing patterns on clinical outcome after renal transplantation. Transplantation 2003; 17:2000.

    Article  Google Scholar 

  11. United States Renal Data System. Researcher’s guide to the USRDS database. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md; 1998.

  12. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transpl 2003; 3:178.

    Article  PubMed  Google Scholar 

  13. Port F, Bragg-Gresham JL, Metzger R, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation 2002; 74:1281.

    Article  PubMed  Google Scholar 

  14. Woodward RS, Schnitzler MA, Baty J, et al. The incidence and cost of new onset diabetes mellitus among US wait-listed and transplanted renal allograft recipients. Am J Transpl 2003; 3:590.

    Article  Google Scholar 

  15. Schnitzler MA, Lowell JA, Hardinger KL, Boxerman SB, Bailey TC, Brennan DC. The association of cytomegalovirus sero-pairing with outcomes and costs following cadaveric renal transplantation prior to the introduction of oral ganciclovir CMV prophylaxis. Am J Transpl 2003; 3:445.

    Google Scholar 

  16. Bullingham RES, Nicholls AJ, Kamm BR. Clinical pharmacokinetics of mycophenolate mofetil. Clin Pharmacokinet 1998; 34:429.

    CAS  PubMed  Google Scholar 

  17. Mourad M, Malaise J, Eddour DC, et al. Correlation of mycophenolate acid pharmacokinetic parameters with side effects in kidney transplant patients treated with mycophenolate mofetil. Clin Chem 2001; 47:88.

    CAS  PubMed  Google Scholar 

  18. Van Gelder T, Hillbrands LB, Vanrenterghem Y, et al. A randomized double-blind, multicenter plasma concentration controlled study of the safety and efficacy of oral mycophenolate mofetil for the prevention of acute rejection after kidney transplantation. Transplantation 1999; 68:261.

    PubMed  Google Scholar 

  19. Hale MD, Nicholls AJ, Bullingham RES, et al. The pharmacokinetic–pharmacodynamic relationship for mycophenolate mofetil in renal transplantation. Clin Pharmacol Ther 1998; 64:672.

    CAS  PubMed  Google Scholar 

  20. Guerard A, Rabodonirina M, Cotte L, et al. Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil. Transplantation 1999; 68:699.

    Article  CAS  PubMed  Google Scholar 

  21. Sarmiento JM, Dockrell DH, Schwab TR, et al. Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients. Clin Transplant 2000; 14:136.

    Article  CAS  PubMed  Google Scholar 

  22. Kaplan B, Meier-Kriesche HU, et al. Prevalence of cytomegalovirus in the gastrointestinal tract of renal transplantation recipients with persistent abdominal pain. Am J Kidney Dis 1999; 34:65.

    CAS  PubMed  Google Scholar 

  23. Schnitzler MA. Diabetes mellitus after kidney transplantation in the United States (letter). Am J Transpl 2003; 3:1381.

    Google Scholar 

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Acknowledgments

Data reported here were supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. Government. This work was supported, in part, by a grant from the National Institute of Diabetes, Digestive, and Kidney, Diseases K25-DK-02916-01, to Mark A. Schnitzler, Ph.D., P.I. Additional support was received from Novartis Pharma AG, Basle, Switzerland.

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Authors and Affiliations

  1. St. Louis College of Pharmacy, St. Louis, Missouri, USA

    Karen L. Hardinger

  2. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA

    Daniel C. Brennan

  3. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    Jeffrey Lowell

  4. Saint Louis University School of Medicine, Center for Outcomes Research, 3545 Lafayette Avenue, St. Louis, Missouri, MO 63104, USA

    Mark A. Schnitzler

  5. Health Administration Program, Washington University School of Medicine, St. Louis, Missouri, USA

    Mark A. Schnitzler

Authors
  1. Karen L. Hardinger
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  2. Daniel C. Brennan
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  3. Jeffrey Lowell
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  4. Mark A. Schnitzler
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Corresponding author

Correspondence to Mark A. Schnitzler.

Additional information

This work was performed while M.A. Schnitzler was at Washington University, St. Louis, Missouri, USA

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Hardinger, K.L., Brennan, D.C., Lowell, J. et al. Long-term outcome of gastrointestinal complications in renal transplant patients treated with mycophenolate mofetil. Transpl Int 17, 609–616 (2004). https://doi.org/10.1007/s00147-004-0768-6

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  • DOI: https://doi.org/10.1007/s00147-004-0768-6

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