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P8.092 Conversion from MPA twice a day to MPA once a day following kidney and pancreas/kidney transplantation

Diego Cantarovich, France

Nephrology and Immunology Clinic
Centre Hospitalier Universitaire de Nantes

Biography

Dr. Diego Cantarovich was born in Buenos Aires (Argentina). He graduated in Medicine from the University of Buenos Aires and completed his fellowship in Nephrology at the University Hospital Edouard Herriot, Lyon, France. Dr. Cantarovich is Professor of Medical Sciences, Université Claude Bernard, Lyon. He completed a PhD in Immunology in Nantes with main interest on islet xenotransplantation. He is a University Hospital Practioner at the Transplantation Institute in Nantes since 1986 were he founded the pancreas and the islet transplant programs. He is a founder member of IPITA and Chairman of the European Pancreas and Islet Transplant Registry since 2020. His main clinical research focuses on pancreas and islet transplantation, and immunosuppression strategies and steroid avoidance in kidney and pancreas/kidney transplantation.

Abstract

Conversion from MPA twice a day to MPA once a day following kidney and pancreas/kidney transplantation

Claire Garandeau1, Jacques Dantal1, Magali Giral1, Maryvonne Hourmant1, Aurelie Meurette1, Gilles Blancho1, Diego Cantarovich1.

1Institute of Transplantation-Urology-Nephrology, Nantes University Hospital, Nantes, France

Introduction: The incidence of immunological graft loss after the first months oy years following kidney transplantation ranges from 30 to 50%. In the majority of cases, non-adherence with the immunosuppressive therapy is considered to be the main reason of rejection. Single daily tacrolimus (Tac) immunosuppression was initiated with the aim of alleviating non-adherence. However, mycophenolate acid (MPA) is almost given in association to Tac but twice a day.

Methods: After a previous pharmacokinetic profile study comparing MPA twice a day versus once a day in 9 kidney transplant patients, we decided in 2017 to prospectively give the total dose of MPA in a single morning oral dose intake to patients already receiving Tac once a day. This was a mono-centre observational study. Patients who accepted to participate gave their consent  and were switched during a regular out-put clinical visit. We included kidney or pancreas/kidney transplant recipients transplanted at least more than 6 months after surgery. Inclusion  lasted 12 months.

Results: Mean follow-up was 16.3 months (6 to 48). 65 patients (53 kidney, 12 pancreas/kidney) were included. 78% (n=51) of recipients received organs from a cadaver donor. 63% (n=41) were not sensitized. Recipient’s mean age was 49.8 years. 40% (n=26) of patients were on steroid maintenance. Mean conversion time to once daily MPA was 33 months after transplantation. Daily dose ranged from 360 to 1440 mg; 57 patients (88%) received 720 mg. At MPA conversion, no DSA was detected among 55 patients (84%) whereas 10 (16%) were DSA positive. During the first 6 months after conversion, 3 (4.6%) patients developed cellular rejection (all reversible), one BKV nephropathy, one pneumonia, and one PTLD.  MPA was only stopped in 2 patients because of gastro-intestinal disorders. No case of severe leukopenia was noted. No other adverse events were observed thereafter. No de novo DSA was noted even among the 3 patient with acute rejection.

Conclusion: Once daily Tac in association to one daily MPA could represent a good strategy to decrease non-adherence and improve quality of life of transplant recipients.

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