+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Renal Transplant Acute Rejection with Lower Mycophenolate Mofetil Dosing and Proton Pump Inhibitors or Histamine-2 Receptor Antagonists



Renal Transplant Acute Rejection with Lower Mycophenolate Mofetil Dosing and Proton Pump Inhibitors or Histamine-2 Receptor Antagonists



PharmacoTherapy 37(12): 1507-1515



Pharmacokinetic data show reduced mycophenolic acid levels in renal transplant recipients taking mycophenolate mofetil (MMF) and proton pump inhibitors (PPIs) concomitantly. This reduced exposure could increase rejection risk. The typical initial MMF dose post renal transplantation is 2 g/day, which often requires dose reduction secondary to side effects. Existing studies have not shown significant acute rejection differences for patients taking MMF-PPI versus patients taking MMF-ranitidine. The purpose of this study was to evaluate clinical outcomes in renal transplant recipients receiving a lower MMF dose than previously studied (1.5 g/day) and either a PPI or histamine-2 receptor antagonist (H2RA). This retrospective cohort study included adult subjects receiving a renal transplant between January 1, 2009, and June 30, 2013. Comparison groups were defined based on acid-suppressing therapy class prescribed at discharge from transplantation. The primary outcome was acute rejection incidence within 1 year posttransplantation. Of 728 renal transplant recipients screened, 522 were included: 183 taking a PPI and 339 taking an H2RA. There was no significant difference in acute rejection within 1 year (H2RA 19% versus PPI 14%, p=0.12) or 3 months (4% vs 5%, p=0.44, respectively) posttransplantation. Maintenance immunosuppression (MMF dose and tacrolimus troughs) was similar between groups at 3 months and 1 year. Graft and patient survivals were favorable (> 95%), and graft function at 1 year was stable and similar between groups. Despite taking lower MMF doses than previously studied, subjects on a PPI compared to an H2RA were not at increased risk of acute rejection within 1 year posttransplantation.

(PDF emailed within 0-6 h: $19.90)

Accession: 060193932

Download citation: RISBibTeXText

PMID: 28976570

DOI: 10.1002/phar.2037


Related references

Concomitant proton pump inhibitors with mycophenolate mofetil and the risk of rejection in kidney transplant recipients. Transplantation 97(5): 518-524, 2014

Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. U.S. Renal Transplant Mycophenolate Mofetil Study Group. Transplantation 60(3): 225-232, 1995

Mycophenolate mofetil for the treatment of refractory, acute, cellular renal transplant rejection. The Mycophenolate Mofetil Renal Refractory Rejection Study Group. Transplantation 61(5): 722-729, 1996

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre-transplant diabetes. Clinical Transplantation 19(2): 279-285, 2005

Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: three-year follow-up. The Mycophenolate Mofetil Acute Renal Rejection Study Group. Transplantation 71(8): 1091-1097, 2001

Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized, double-blind, clinical studies in prevention of rejection. The International Mycophenolate Mofetil Renal Transplant Study Groups. Transplantation 63(1): 39-47, 1997

Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: The Mycophenolate Mofetil Acute Renal Rejection Study Group. Transplantation 65(2): 235-241, 1998

Prevention of stress induced ulcers: histamine-2 receptor antagonists or proton pump inhibitors? - gastric hemorrhage occur more often under proton pump inhibitors. Deutsche Medizinische Wochenschrift 139(25-26): 1338, 2014

Mycophenolate mofetil to rescue children with acute renal transplant rejection. Lancet 347(9016): 1699-1700, 1996

Mycophenolate mofetil for the treatment of refractory, acute, cellular renal transplant rejection. Transplantation 61(5): 722-729, 1996

Does mycophenolate mofetil decrease the recurrent acute rejection in renal transplant recipients. International Urology and Nephrology 37(3): 615-619, 2005

Proton pump inhibitors, histamine-2 receptor antagonists, gastroprotection and lower gastrointestinal tract bleeding in low-dose aspirin users. Digestive and Liver Disease 48(2): 211, 2016

Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists and Risk of Pneumonia in Patients with Acute Stroke. Journal of Stroke and Cerebrovascular Diseases 25(5): 1035-1040, 2017

A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. Transplantation 61(7): 1029-1037, 1996

Mycophenolate mofetil, along with ATG and cyclosporine, significantly lowers the incidence of acute rejection episodes in renal transplant recipients. Transplantation Proceedings 31(6): 2259-2260, 1999