Adverse effects of mycophenolate mofetil in pediatric renal transplant recipients with presumed chronic rejection

Background. Mycophenolate mofetil (MMF) has been shown to be superior to az athioprine in reducing the incidence of acute rejection in adult renal tran splant recipients. Although MMF is also being widely used in pediatric tran splant patients, data documenting its safety are limited. Methods. A retrospective review of the transplant records at St. Christophe r's Hospital for Children was conducted to identify patients who had receiv ed MMF. Results. Twenty-four children were switched from azathioprine to MMF, 4.8+/ -2.9 years after transplantation. After an additional 0.8+/-0.4 years, MMF had been discontinued in 13 patients (54%) because of adverse effects (AE). The only variable that predicted the development of AE was a lower calcula ted creatinine clearance at the time of initiation of MMF. Conclusions. In pediatric renal transplant recipients with impaired renal f unction, the use of MMF at the recommended dose is associated with an unacc eptably high incidence of AE; in such patients, the MMF dose may require mo dification for the level of renal function.