PMID- 26637210 OWN - NLM STAT- MEDLINE DCOM- 20160628 LR - 20181113 IS - 1471-2369 (Electronic) IS - 1471-2369 (Linking) VI - 16 DP - 2015 Dec 4 TI - Low dose of mycophenolate mofetil is enough in desensitized kidney transplantation using rituximab. PG - 201 LID - 10.1186/s12882-015-0201-7 [doi] LID - 201 AB - BACKGROUND: Rituximab is widely used in kidney transplantation. However, it is not clear whether the conventional doses of maintenance immunosuppressant in rituximab-treated kidney transplantation (KT) are appropriate. In our previous study, decreasing mycophenolate mofetil (MMF) dose due to infection did not increase the incidence of rejection or graft failure. Based on these experiences, we developed a new protocol with a lower dose of MMF and studied its clinical outcomes in rituximab-treated KT. METHODS: We enrolled all patients who underwent ABO-incompatible or human leukocyte antigen (HLA)-sensitized living donor KT with the new immunosuppressant protocol after preconditioning with rituximab, but without splenectomy from November 2011 to May 2013. Seventy-two patients (group 1) were consecutively enrolled in this study and followed until November 2013. Patients from our previous study served as control groups. Sixty-seven patients received KT using rituximab with a conventional dose of MMF (group 2), and 87 patients received ABO compatible KT without need for rituximab (group 3). Clinical outcomes, including rejection, infection, and graft survival, were compared between the groups. The chi (2) test and Fisher's exact test were used for categorical variables, the Student's t-test and Mann-Whitney U test were used for continuous variables, and a log-rank test was used for mortality analysis. RESULTS: Doses of postoperative MMF (g/day) were lower in group 1 than in the other groups (1.03 +/- 0.19, 1.48 +/- 0.34 and 1.48 +/- 0.32 g/day at 1 week, p < 0.001). Infectious complications occurred more often in groups with conventional MMF doses (group 2 and 3) than in group 1 (16.7 vs. 37.3 %, p = 0.007 and 16.7 vs. 34.5 %, p = 0.012, respectively). Notably, group 1 showed a lower incidence of cytomegalovirus infection than group 2. However, reduction in MMF dose did not increase the incidence of acute rejection (4.2, 4.5 and 10.3 %). Only one graft failure occurred in group 2 due to vessel kinking after operation. There were no significant differences in the incidence of malignancy and mortality between groups. CONCLUSIONS: A low MMF dose reduces infection without increasing rejection or graft loss and it may be appropriate to reduce the dose of MMF for rituximab-treated KT patients. FAU - Baek, Chung Hee AU - Baek CH AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. bch393@naver.com. FAU - Kim, Hyosang AU - Kim H AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. mateus111@daum.net. FAU - Yu, Hoon AU - Yu H AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. yuhoon721@gmail.com. FAU - Shin, Eunhye AU - Shin E AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. seh82@naver.com. FAU - Cho, Hyungjin AU - Cho H AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. yourhyungjin@hanmail.net. FAU - Yang, Won Seok AU - Yang WS AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. wsyang@amc.seoul.kr. FAU - Han, Duck Jong AU - Han DJ AD - Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. djhan@amc.seoul.kr. FAU - Park, Su-Kil AU - Park SK AD - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. skpark@amc.seoul.kr. LA - eng PT - Controlled Clinical Trial PT - Journal Article DEP - 20151204 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Immunologic Factors) RN - 0 (Immunosuppressive Agents) RN - 4F4X42SYQ6 (Rituximab) RN - HU9DX48N0T (Mycophenolic Acid) SB - IM MH - Adult MH - Anti-Inflammatory Agents, Non-Steroidal/administration & dosage MH - Drug Administration Schedule MH - Drug Therapy, Combination/methods MH - Female MH - Graft Rejection/*etiology/*prevention & control MH - Humans MH - Immunologic Factors/administration & dosage MH - Immunosuppressive Agents/administration & dosage MH - Kidney Transplantation/*adverse effects MH - Male MH - Mycophenolic Acid/administration & dosage/*analogs & derivatives MH - Nephritis/*chemically induced/prevention & control MH - Rituximab/*administration & dosage MH - Treatment Outcome PMC - PMC4670498 EDAT- 2015/12/08 06:00 MHDA- 2016/06/29 06:00 PMCR- 2015/12/04 CRDT- 2015/12/06 06:00 PHST- 2015/09/18 00:00 [received] PHST- 2015/11/30 00:00 [accepted] PHST- 2015/12/06 06:00 [entrez] PHST- 2015/12/08 06:00 [pubmed] PHST- 2016/06/29 06:00 [medline] PHST- 2015/12/04 00:00 [pmc-release] AID - 10.1186/s12882-015-0201-7 [pii] AID - 201 [pii] AID - 10.1186/s12882-015-0201-7 [doi] PST - epublish SO - BMC Nephrol. 2015 Dec 4;16:201. doi: 10.1186/s12882-015-0201-7.