Latest news with #transplantrecipients
Medscape
24-07-2025
- Health
- Medscape
Drug Level Changes Predict Renal Transplant Success in Kids
TOPLINE: In paediatric kidney transplant recipients, high variability in tacrolimus trough blood levels was significantly associated with allograft rejection occurring beyond 12 months post-transplant; however, rapid tacrolimus metabolism was significantly associated with rejection episodes occurring between 6 and 12 months. METHODOLOGY: Tacrolimus remains essential in contemporary immunosuppressive regimens, yet its narrow therapeutic window and wide interpatient and intrapatient variability complicate dosing. Although high variability in tacrolimus blood levels and a low concentration-to-dose (C/D) ratio — an approximation of tacrolimus metabolism — predict kidney transplant rejection in adults, comparable paediatric data are scarce. Researchers in Germany conducted a retrospective study to assess the predictive value of tacrolimus intrapatient variability (TacIPV) and C/D ratio for transplant outcomes in children receiving kidney transplantation. They analysed 13,159 tacrolimus trough blood levels in 255 paediatric kidney transplant recipients (median age at transplantation, 11 years; 59% boys) who received a tacrolimus-based immunosuppressive regimen; the median follow-up duration was 60 months. TacIPV was quantified during months 6-12 post-transplant, and the C/D ratio was evaluated during both early (first 6 months) and late (6-12 months) periods. Measured outcomes encompassed the incidence of allograft rejection, the occurrence of opportunistic infections, and the degree of graft dysfunction. TAKEAWAY: Overall, allograft rejection occurred in 45% of patients — 9% within the first 6 months post-transplant, 6% between 6 and 12 months, and 30% after 12 months. High TacIPV during months 6-12 post-transplant was associated with an increased risk for allograft rejection beyond 12 months post-transplant (hazard ratio [HR], 1.04; P = .002); a TacIPV threshold of more than 23% could distinguish patients who did vs did not experience allograft rejection. A low C/D ratio during the first 6 months post-transplant was correlated with a higher risk for allograft rejection between months 6 and 12 (inverse HR, 3.13; 95% CI, 1.05-9.09; P = .04); a C/D ratio cutoff of less than 1.0 could distinguish patients who did vs did not experience allograft rejection. Opportunistic infections and graft dysfunction occurred in 42% and 10% of patients, respectively. IN PRACTICE: "TacIPV and C/D ratio may serve as cost-effective, non-invasive predictive markers for early identification of patients at risk for rejection," the authors wrote. SOURCE: This study was led by Maral Baghai Arassi, Department of Pediatrics I, Medical Faculty, University Children's Hospital, Heidelberg, Germany. It was published online on July 21, 2025, in Pediatric Nephrology. LIMITATIONS: This study could not establish direct causal relationships between tacrolimus exposure, the factors influencing it, and transplant outcomes. The cohort may not fully represent the broader population of kidney transplant recipients as patients with incomplete tacrolimus monitoring data were excluded. Additionally, as most patients were of Caucasian descent, the findings may not fully generalise to more diverse populations. DISCLOSURES: This study was supported by a Young Investigator Award from the European Society for Paediatric Nephrology; a grant from Chiesi, Germany; and other sources. One author reported receiving research grants and consulting fees from various pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
22-07-2025
- Health
- Medscape
Cancer Risk in MMF-Treated Patients Differs by Indication
TOPLINE: Patients with dermatologic conditions showed a 74% lower risk for malignancy with mycophenolate mofetil (MMF) than transplant patients, a study found. METHODOLOGY: Researchers conducted a single-center retrospective chart of patients who had taken MMF for ≥ 5 years between 2012 and 2025 at Atrium Health Wake Forest Baptist Medical Center. The analysis included 126 patients (mean age, 64.2 years; 35.7% men) who received MMF for dermatologic conditions, 226 organ transplant recipients (mean age, 59.6 years; 61.5% men) who received MMF plus other immunosuppressive agents, and 296 patients (mean age, 64.1 year; 34.5% men) with dermatologic conditions who had no exposure to systemic immunosuppression. About two thirds of patients were White individuals and one fourth were Black individuals. Dermatologic patients received a mean daily MMF dose of 1390 mg over an average of 7.5 years, while transplant recipients received a lower mean daily dose of 807 mg for a mean duration of 9.9 years. Concomitant immunosuppressive therapy was administered to 40% of the patients with dermatologic conditions (MMF plus prednisone) and to 100% of transplant recipients (tacrolimus, prednisone, or cyclosporine). Researchers compared malignancy rates between the groups. TAKEAWAY: Overall, 9.5% of the dermatologic patients who received MMF developed malignancies compared with 36% of the transplant recipients (P < .0001); the risk for malignancy was 74% lower in dermatologic patients treated with MMF (95% CI, 0.1487-0.4518). No difference was found between dermatologic patients who received MMF vs those without exposure to systemic immunosuppression (8.4%). Cutaneous malignancies were significantly more common in transplant patients than in dermatologic patients who received MMF (26.5% vs 5.6%; P < .0001). The prevalence of urological/reproductive cancers was higher in transplant patients than dermatologic patients treated with MMF (9.3% vs 2.4%; P = .0143). IN PRACTICE: 'The use of MMF for dermatologic conditions does not appear to expose patients to the same malignancy risk as those treated with MMF and other chronic immunosuppressive treatments in the transplant setting and did not confer an elevated malignancy risk compared to dermatologic patients without systemic immunosuppression,' the authors of the study wrote. SOURCE: The study was led by Robin Yi, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and was published online on July 17 in the Journal of the American Academy of Dermatology. LIMITATIONS: Limitations included the MMF dosing variability and small sample size. DISCLOSURES: The study did not receive any funding. One author reported receiving research, speaking and consulting support from numerous pharmaceutical companies including Eli Lilly, GlaxoSmithKline/Stiefel, AbbVie, and Janssen and disclosed being founder and part owner of Causa Research and holding stock in Sensal Health. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
