Safety and Efficacy of Weight-Based MMF (Cellcept) Dosing in Kidney Transplant Recipients: A Quality Improvement Study
Bibliographic record
Abstract
Background: Mycophenolate mofetil (MMF) reduces the risk of acute rejection (AR) in kidney transplant recipients (KTRs) and improves post-transplant graft survival. MMF is usually prescribed in fixed doses (2 gm/day). Due to its side effects, MMF doses often require reduction. Weight-based MMF dosing (10-16 mg/kg/day) was correlated with therapeutic level in Asian KTRs. We are aiming to evaluate the safety and efficacy of weight-based MMF dosing at 15 mg/kg/day, adopted by our program in September 2021. Methods: This is a single center retrospective quality improvement study evaluating the safety and efficacy of weight-based MMF dosing at 15 mg/kg/day, compared with non-weight-based doses (≤ 2 gm/day), to reduce the risk of MMF-associated side effects including leukopenia (WBC ≤ 3.5), BK- and/or CMV-viremia, while monitoring the risk of AR associated with reduced MMF doses. All KTRs followed in our kidney transplant clinic at Queen’s University between September 1, 2021, and August 31, 2023, were included. Results: 230 KTRs [Age 56.9±14.4 years, Female (36.1%), Caucasian (87.8%)] were included. By August 31, 2023, 112 (48.7%) patients were on MMF. 18 patients were on weight-based doses (15.9 (14.9-18.1) mg/kg/day). 17 patients were on fixed doses (20.7 (17.2-26.2) mg/kg/day). 68.8% of MMF patients were on reduced doses (14.4 (10.4-14.4) mg/kg/day) due to adverse effects, most notably leukopenia (25%) and BK-viremia (18%). At the end of the study, leukopenia, BK- and CMV-viremia were active in 4 (1.7%), 7 (3%) and 1 (0.4%) of all patients, respectively and none of them were on weight-based MMF doses. Median eGFR of MMF patients was higher than non-MMF patients (58 vs. 53 ml/min per 1.73 sm; P 0.37), and it was better among patients on weight-based MMF doses compared with fixed (68.5 vs. 51; P 0.035) and reduced doses (58; P 0.26). Conclusion: Snapshot data showed a low rate of leukopenia, BK- and CMV-viremia/infection, likely due to effective MMF dose reduction. Further analysis will be done through our next retrospective cohort study to evaluate the outcomes of weight-based dosing. Funding: Private Foundation Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".