Journal
CLINICAL TRANSPLANTATION
Volume 28, Issue 2, Pages 184-191Publisher
WILEY-BLACKWELL
DOI: 10.1111/ctr.12294
Keywords
African American; race; enteric-coated mycophenolate sodium; EC-MPS; Myfortic; kidney transplantation; mycophenolate mofetil; MMF - Cellcept; outcomes
Categories
Funding
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
- Novartis Pharmaceuticals Corporation
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Mycophenolic acid Observational REnal transplant (MORE) was a prospective, observational study of de novo kidney transplant patients receiving mycophenolic acid (MPA). Four-yr data on 904 patients receiving tacrolimus and enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) were analyzed to evaluate immunosuppression and graft outcomes in African American (AA, n=218) vs. non-AA (n=686) patients. Mean tacrolimus dose was higher in AA vs. non-AA patients but mean tacrolimus trough concentration was similar. Use of the recommended MPA dose in AA patients decreased from 78.9% at baseline to 33.1% at year 3. More AA patients received the recommended MPA dose with EC-MPS than MMF at month 6 (56.2% vs. 35.7%, p=0.016) and month 36 (46.6% vs. 16.7%, p=0.029), with no safety penalty. Significantly, more AA patients received corticosteroids than non-AA patients. Biopsy-proven acute rejection was higher in AA vs. non-AA patients (18.9% vs. 10.7%, p=0.003), as was graft loss (10.9% vs. 4.4%, p=0.003); differences were confirmed by Cox regression analysis. Patient survival was similar. Estimated GFR was comparable in AA vs. non-AA patients. Kidney allograft survival remains lower for AA vs. non-AA recipients even under the current standard of care.
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