Purpose To determine the prevalence of mycophenolic acid (Myfortic) use as part of the immunosuppressant regime in our current paediatric renal transplant recipients in a single tertiary paediatric nephrology centre and examine the demography of these cases.
Method Case note and pharmacy record review of all paediatric renal transplant recipients' history, immunosuppressant medication and current renal allograft function in January 2013. Indication for medication switch from mycophenolate mofetil to enteric-coated mycophenolic acid tablets (Myfortic) was noted. Data presented as median (range).
Results 14 (10 male) out of a total of 88 patients with renal transplants are currently receiving Myfortic in our centre. Age and time from transplant was 12.3 (8.1–17.4) years and 4.3 (0.68–10.6) years. The most common cause of end stage renal disease requiring transplantation in this subgroup was posterior urethral valves in 5/14 cases. Two of these recipients had ABO incompatible living related transplants. Current eGFR was 46.7 (20.9–82.3) ml/min/1.73m.2 All patients receiving Myfortic were also receiving prednisolone and tacrolimus as part of their immunosuppression regime. Dosage of Myfortic varied based on patient size from 180 mg twice daily to 720 mg twice daily.
The indication for carrying out a medication switch from mycophenolate mofetil to Myfortic was related to gastrointestinal symptoms in all cases; specifically diarrhoea in 9 cases, abdominal pain in 2 cases and both symptoms in 3 cases. These symptoms improved on Myfortic with renal allograft function remaining stable, however in view of neutropenia in one patient her Myfortic is currently suspended and under review.
Conclusion We have found that enteric-coated mycophenolic acid (Myfortic) was a well-tolerated alternative in paediatric renal allograft recipients who developed gastrointestinal symptoms whilst receiving mycophenolate mofetil. Its usage should be considered in such patients who are able to take tablet preparations.
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