The impact of age on patient tolerance of mycophenolate following kidney transplantation

Tineke Rennie, Michaela Petrie, Wendy Metcalfe, David Walbaum, Nicola Joss, Ellen Barton, Lorna P Marson, Marc J Clancy, Lorna Henderson, Jamie P. Traynor, Colin Geddes, Paul J Phelan

Research output: Contribution to journalArticlepeer-review


Background: In Scotland, standard maintenance immunosuppression following kidney transplantation consists of mycophenolate (MPA), tacrolimus and prednisolone irrespective of recipient age. We analysed the tolerability of this immunosuppression regimen and the association with transplant outcomes.
Methods: A national, multicentre retrospective analysis of patients transplanted in 2015 and 2016, comparing graft function, acute rejection, significant infection rates and immunosuppression dosing between patients aged 18-59 years (Group 1) and ≥60 years (Group 2).
Results: Of the 490 patients, 26% were aged ≥60 years. Acute rejection (AR) rates at 1 year were 15% and 11% in Group 1 and 2 respectively. Full dose MPA was poorly tolerated with 53% in Group 1 and 77% in Group 2 requiring dose reduction or cessation. Female gender and age ≥60 years were independent predictors for MPA dose changes. One year following MPA dose reduction AR risk was low (5%) in Group 2, however those remaining on full dose MPA had a 79% increased rate of serious infections.
Conclusion: The majority of renal transplant recipients aged ≥60 fail to tolerate full dose MPA. In this group, MPA dose reduction is associated with low rejection rates, but full dose MPA is associated with high infection rates. We suggest that a tailored approach to immunosuppression in elderly recipients incorporating lower doses of MPA may be appropriate.
Original languageEnglish
Early online date4 May 2020
Publication statusPublished - Jun 2020


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