Single-center experience with mycophenolate mofetil in pediatric renal transplant recipients

Mycophenolate mofetil(MMF), a potent and specific inhibitor of guanosine nu cleotide synthesis, is a new immunosuppressive drug used to prevent rejecti on in transplant patients. Extensive data on its utility and efficacy exist s in adult patients but there is limited experience in pediatrics. Twenty-f our children (14 male, 10 female,2-19 yr of age), eight of whom had receive d living-related donor (LRD) transplants and 16 of whom had received cadave ric donor (CD) transplants, have been treated with MMF in our institution s ince September 1996, MMF was administered for a duration ranging from 13 we eks to 38 months, at an average dose of 600 mg/m(2) rrange: 200-1,000 mg/do se) every 12 h, for a total experience of 304 patient months. MMF capsules were used in 16 patients and/or pediatric suspension in eight. Five patient s were switched to MMF from azathioprine as a result of rejection episodes or inability to taper prednisone, between 5 weeks and 3.5 yr post-transplan t. All patients received prednisone, cyclosporin A (CsA), and induction the rapy with anti-lymphocyte globulin (19 patients), anti-thymocyte globulin t one patient) or daclizumab (four patients). In 13 patients started on MMF a t the time of CD transplant, five (42%) had an acute rejection episode. In seven who received a LRD transplant, one (14%,) had an acute rejection epis ode. No patients who were converted to MMF were treated for acute rejection following conversion to MMF. One LRD graft was lost at 19 days following i njury to the donor artery at the time of retrieval. At the last follow-up, the average creatinine level was 93 mu mol/L and average urea level was 8.6 mmol/L. One patient developed epigastric distress. Three patients develope d diarrhea/abdominal pain requiring dose adjustment. Five episodes of leuko penia and one episode of thrombocytopenia required dose adjustment. Two pat ients developed symptomatic cytomegalovirus (CMV) infection, one while on a cyclovir prophylaxis. No malignancy has been encountered to date. Hence, MM F can be administered safely to children with good effect and with an accep table side-effect profile.