Clinical Outcomes of Early Mycophenolate Mofetil Reduction Protocol in Kidney-Transplant Recipients Desensitized with Rituximab

Abstract

Background: Standard triple immunosuppressive regimen in kidney transplant(KT) recipients desensitized with rituximab was generally accepted as an effective protocol. But recently, to avoid excessive immunosuppression and the concomitant risk of infection, a tendency has prevailed to reduce the intensity of immunosuppressive agent. Therefore, we prospectively investigated the clinical outcomes of early MMF reduction protocol in KT recipients desensitized with rituximab. Patients and method: A total of 25 patients who received kidney transplantation at Asan Medical Center during November, 2011 was enrolled. We divided the patients into two groups based on rituximab desensitization; Group I (n=9): ABO incompatible or T-flow positive, Group II (n=16): ABO compatible and T-flow negative. Group I was treated with early MMF reduction protocol (1.5g/d bid dosing of MMF was started at 7-10 days before KT and reduced 1.0g/day bid dosing at 7 days after KT) The Incidence of acute rejection, infection and gastrointestinal adverse effects during 2 months in two groups were compared. Result: No significant difference regarding the baseline characteristics, age, sex, duration of dialysis, HLA mismatching, Panel-reactive antibody level was detected. Patient and graft survival of two groups was 100% after 2 month. Acute rejection was occurred in each one patient of group I (11%) and Group II (6%). the patient of Group I was recovered after steroid pulse therapy without biopsy and the patient of Group II was confirmed acute T-cell mediated rejection IIB with biopsy. The incidence of infection was higher in Group I (22%) than Group II (6%) but there was no statistical significance. Cystitis and varicella zoster were diagnosed in two patients of Group I and pyelonephritis was occurred in one patient of Group II. There was no cytomegalovirus and BK virus infection in two groups. Gastrointestinal side effect, nausea and vomiting was presented in one patient of Group I but improved after changing MMF into myfortic. Conclusion: This short-term clinical outcomes suggest that the early MMF reduction protocol may prove effective as a immunosuppression regimen for KT recipients desensitized with rituximab. Lager and longer trials are needed to evaluate.