Trijntje J W Rennie1, Michaela Petrie1, Wendy Metcalfe1,2, David Walbaum3, Nicola Joss4, Ellen Barton5, Lorna Marson1,6, Marc J Clancy7, Lorna Henderson1, Jamie P Traynor2,7, Colin G Geddes7, Paul J Phelan1. 1. Renal Department, NHS Lothian - Royal Infirmary Edinburgh, Edinburgh, UK. 2. The Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow, UK. 3. Renal Department, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK. 4. Renal Department, NHS Highland, Raigmore Hospital, Inverness, UK. 5. School of Medicine, The University of Edinburgh, Edinburgh, UK. 6. Division of Health Sciences, The University of Edinburgh, Edinburgh, UK. 7. Department of Renal Transplantation, NHS Great Glasgow and Clyde - Queen Elizabeth University Hospital, Glasgow, UK.
Abstract
BACKGROUND: In Scotland, standard maintenance immunosuppression following kidney transplantation consists of mycophenolate (MPA), tacrolimus and prednisolone irrespective of recipient age. We analyzed the tolerability of this immunosuppression regimen and the association with transplant outcomes. METHODS: A national, multicentre retrospective analysis of patients transplanted in 2015 and 2016, comparing graft function, acute rejection, significant infection rates and immunosuppression dosing between patients aged 18 and 59 years (Group 1) and ≥60 years (Group 2). RESULTS: Of the 490 patients, 26% were aged ≥60 years. Acute rejection (AR) rates at 1 year were 15% and 11% in Groups 1 and 2, respectively. Full-dose MPA was poorly tolerated with 53% in Group 1 and 77% in Group 2 requiring dose reduction or cessation. Female gender and age ≥60 years were independent predictors for MPA dose changes. One year following MPA dose reduction, AR risk was low (5%) in Group 2, however, those remaining on full dose MPA had a 79% increased rate of serious infections. CONCLUSION: The majority of renal transplant recipients aged ≥60 fail to tolerate full-dose MPA. In this group, MPA dose reduction is associated with low rejection rates, but full-dose MPA is associated with high infection rates. We suggest that a tailored approach to immunosuppression in elderly recipients incorporating lower doses of MPA may be appropriate.
BACKGROUND: In Scotland, standard maintenance immunosuppression following kidney transplantation consists of mycophenolate (MPA), tacrolimus and prednisolone irrespective of recipient age. We analyzed the tolerability of this immunosuppression regimen and the association with transplant outcomes. METHODS: A national, multicentre retrospective analysis of patients transplanted in 2015 and 2016, comparing graft function, acute rejection, significant infection rates and immunosuppression dosing between patients aged 18 and 59 years (Group 1) and ≥60 years (Group 2). RESULTS: Of the 490 patients, 26% were aged ≥60 years. Acute rejection (AR) rates at 1 year were 15% and 11% in Groups 1 and 2, respectively. Full-dose MPA was poorly tolerated with 53% in Group 1 and 77% in Group 2 requiring dose reduction or cessation. Female gender and age ≥60 years were independent predictors for MPA dose changes. One year following MPA dose reduction, AR risk was low (5%) in Group 2, however, those remaining on full dose MPA had a 79% increased rate of serious infections. CONCLUSION: The majority of renal transplant recipients aged ≥60 fail to tolerate full-dose MPA. In this group, MPA dose reduction is associated with low rejection rates, but full-dose MPA is associated with high infection rates. We suggest that a tailored approach to immunosuppression in elderly recipients incorporating lower doses of MPA may be appropriate.
Authors: Georgina Nakafero; Matthew J Grainge; Tim Card; Christian D Mallen; Richard Riley; Danielle van der Windt; Christopher P Fox; Maarten W Taal; Guruprasad P Aithal; Hywel C Williams; Abhishek Abhishek Journal: Rheumatol Adv Pract Date: 2022-06-02