{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:58:16Z","timestamp":1785455896092,"version":"3.56.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006260","name":"Technion - Israel Institute of Technology","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006260","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Temporary discontinuation of mycophenolate mofetil (MMF) is frequently required in pediatric kidney transplant recipients, most often in response to viral complications. However, data regarding the long-term safety of MMF discontinuation, feasibility of reintroduction, and predictors of the need for MMF withdrawal in children remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single-center cohort study of pediatric kidney transplant recipients with longitudinal follow-up. Clinical, virologic, immunologic, and transplant-related data were collected. Outcomes included longitudinal estimated glomerular filtration rate (eGFR), biopsy-proven acute rejection, graft loss, de novo donor-specific antibody (dnDSA) development, unplanned hospitalization, and MMF reintroduction. Factors associated with MMF discontinuation were evaluated using multivariable regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 65 pediatric kidney transplant recipients, 22 (33.8%) required temporary MMF discontinuation, most commonly within the first post-transplant year. Opportunistic viral infections accounted for the majority of MMF withdrawal events, with BK virus as the predominant indication. MMF reintroduction was feasible in most patients (15\/22). Longitudinal eGFR trajectories, rates of rejection, graft loss, dnDSA development, and unplanned hospitalization did not differ between patients who discontinued MMF and those who maintained full therapy. Younger age at transplantation emerged as the sole independent predictor of the need for MMF discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real-world pediatric cohort, temporary MMF discontinuation, when clinically indicated, closely monitored, and followed by cautious reintroduction, was not associated with adverse long-term graft outcomes. Younger age at transplantation was associated with a higher likelihood of MMF discontinuation, supporting individualized immunosuppression strategies and proactive efforts to identify children at risk for viral-driven immunosuppression intolerance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-026-07231-8","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T06:20:59Z","timestamp":1776147659000},"page":"3059-3067","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporary mycophenolate discontinuation and reintroduction in pediatric kidney transplantation: predictors and long-term outcomes"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8489-715X","authenticated-orcid":false,"given":"Moran","family":"Plonsky Toder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Pollack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Tibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Libinson-Zebegret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Yakubov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella","family":"Magen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"7231_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14077","volume":"25","author":"SS Balani","year":"2021","unstructured":"Balani SS, Jensen CJ, Kouri AM, Kizilbash SJ (2021) Induction and maintenance immunosuppression in pediatric kidney transplantation\u2014advances and controversies. Pediatr Transplant 25:e14077. https:\/\/doi.org\/10.1111\/petr.14077","journal-title":"Pediatr Transplant"},{"key":"7231_CR2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.856630","volume":"10","author":"L Oomen","year":"2022","unstructured":"Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W (2022) Pearls and pitfalls in pediatric kidney transplantation after 5 decades. Front Pediatr 10:856630. https:\/\/doi.org\/10.3389\/fped.2022.856630","journal-title":"Front Pediatr"},{"key":"7231_CR3","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1186\/s12882-021-02460-5","volume":"22","author":"J Dudley","year":"2021","unstructured":"Dudley J, Christian M, Andrews A, Andrews N, Baker J, Boyle S, Convery M, Gamston F, Garcia M, Haq S, Hegde S, Holt R, Jones H, Khan S, McCaughan J, Milford D, Pickles C, Reynolds B, Sathyanarayana V, Stojanovic J, Tse Y, Wallace D, Walsh G, Ware N, Williams A, Yadav P, Marks S (2021) Clinical practice guidelines standardisation of immunosuppressive and anti-infective drug regimens in UK paediatric renal transplantation: the harmonisation programme. BMC Nephrol 22:312. https:\/\/doi.org\/10.1186\/s12882-021-02460-5","journal-title":"BMC Nephrol"},{"issue":"3","key":"7231_CR4","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1111\/j.1600-6143.2009.02834.x","volume":"9","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group","year":"2009","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(3):S1-155. https:\/\/doi.org\/10.1111\/j.1600-6143.2009.02834.x","journal-title":"Am J Transplant"},{"key":"7231_CR5","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1432027","volume":"12","author":"L Oomen","year":"2024","unstructured":"Oomen L, Bootsma-Robroeks CMHHT, Bouts AHM, Carbonell Pradas M, Gander R, Kienzl-Wagner K, K\u00f6nig P, Pereira PL, Dunand O, Mosca SMFS, Pac M, Podracka L, Prytula AA, Sangermano M, Vitkevic R, Zieg J, van der Zanden LFM, Feitz WFJ, de Wall LL (2024) Pediatric kidney transplantation in Europe, a clinical snapshot pilot. Front Pediatr 12:1432027. https:\/\/doi.org\/10.3389\/fped.2024.1432027","journal-title":"Front Pediatr"},{"key":"7231_CR6","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13597","volume":"23","author":"A Chua","year":"2019","unstructured":"Chua A, Cramer C, Moudgil A, Martz K, Smith J, Blydt-Hansen T, Neu A, Dharnidharka VR, NAPRTCS investigators (2019) Kidney transplant practice patterns and outcome benchmarks over 30\u00a0years: the 2018 report of the NAPRTCS. Pediatr Transplant 23:e13597. https:\/\/doi.org\/10.1111\/petr.13597","journal-title":"Pediatr Transplant"},{"key":"7231_CR7","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14628","volume":"28","author":"A Moudgil","year":"2024","unstructured":"Moudgil A, Sgambat K, Benoit E, Seifert ME, Bharadwaj M, Jain A, Mansuri A, Harshman L, Katsoufis C, Somers M (2024) Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: a PNRC study. Pediatr Transplant 28:e14628. https:\/\/doi.org\/10.1111\/petr.14628","journal-title":"Pediatr Transplant"},{"key":"7231_CR8","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1097\/01.asn.0000079616.71891.f5","volume":"14","author":"GA Knoll","year":"2003","unstructured":"Knoll GA, MacDonald I, Khan A, Van Walraven C (2003) Mycophenolate mofetil dose reduction and the risk of acute rejection after renal transplantation. J Am Soc Nephrol 14:2381\u20132386. https:\/\/doi.org\/10.1097\/01.asn.0000079616.71891.f5","journal-title":"J Am Soc Nephrol"},{"key":"7231_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001697","volume":"10","author":"K Yatim","year":"2024","unstructured":"Yatim K, Al Jurdi A, El Mouhayyar C, Morena L, Hullekes FE, Verhoeff R, Ribas GT, Pearson DS, V Riella L (2024) Safety and efficacy of a preemptive Mycophenolate Mofetil dose reduction strategy in kidney transplant recipients. Transplant Direct 10:e1697. https:\/\/doi.org\/10.1097\/TXD.0000000000001697","journal-title":"Transplant Direct"},{"key":"7231_CR10","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14880","volume":"28","author":"A-M Gramkow","year":"2024","unstructured":"Gramkow A-M, Baatrup JH, Gramkow ET, Koefoed-Nielsen P, Wittenhagen P, Thiesson HC (2024) The impact of reduced immunosuppression on alloimmunity: a retrospective study of pediatric kidney transplant recipients. Pediatr Transplant 28:e14880. https:\/\/doi.org\/10.1111\/petr.14880","journal-title":"Pediatr Transplant"},{"key":"7231_CR11","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s00467-025-07030-7","volume":"41","author":"H Kaijansinkko","year":"2026","unstructured":"Kaijansinkko H, Tainio J, Bjerre A, Gjerstad AC, Weinreich IDS, Jalanko H, Wennberg L, Westphal Ladfors S, Thiesson HC, Bekassy Z, S\u00f8rensen SS, Jahnukainen T (2026) Changes in maintenance immunosuppression after pediatric kidney transplantation\u2014a report from the Nordic pediatric kidney transplantation registry. Pediatr Nephrol 41:547\u2013556. https:\/\/doi.org\/10.1007\/s00467-025-07030-7","journal-title":"Pediatr Nephrol"},{"key":"7231_CR12","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.2215\/CJN.08741209","volume":"5","author":"M Zappitelli","year":"2010","unstructured":"Zappitelli M, Zhang X, Foster BJ (2010) Estimating glomerular filtration rate in children at serial follow-up when height is unknown. Clin J Am Soc Nephrol 5:1763\u20131769. https:\/\/doi.org\/10.2215\/CJN.08741209","journal-title":"Clin J Am Soc Nephrol"},{"key":"7231_CR13","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00467-014-2866-8","volume":"30","author":"JM Smith","year":"2015","unstructured":"Smith JM, Dharnidharka VR (2015) Viral surveillance and subclinical viral infection in pediatric kidney transplantation. Pediatr Nephrol 30:741\u2013748. https:\/\/doi.org\/10.1007\/s00467-014-2866-8","journal-title":"Pediatr Nephrol"},{"key":"7231_CR14","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14199","volume":"26","author":"S Levi","year":"2022","unstructured":"Levi S, Davidovits M, Alfandari H, Dagan A, Borovitz Y, Bilavsky E, Landau D, Haskin O (2022) EBV, CMV, and BK viral infections in pediatric kidney transplantation: frequency, risk factors, treatment, and outcomes. Pediatr Transplant 26:e14199. https:\/\/doi.org\/10.1111\/petr.14199","journal-title":"Pediatr Transplant"},{"key":"7231_CR15","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1097\/TP.0000000000004976","volume":"108","author":"CN Kotton","year":"2024","unstructured":"Kotton CN, Kamar N, Wojciechowski D, Eder M, Hopfer H, Randhawa P, Sester M, Comoli P, Tedesco Silva H, Knoll G, Brennan DC, Trofe-Clark J, Pape L, Axelrod D, Kiberd B, Wong G, Hirsch HH, Transplantation Society International BK Polyomavirus Consensus Group (2024) The second international consensus guidelines on the management of BK polyomavirus in kidney transplantation. Transplantation 108:1834\u20131866. https:\/\/doi.org\/10.1097\/TP.0000000000004976","journal-title":"Transplantation"},{"key":"7231_CR16","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad293","volume":"17","author":"S Pollack","year":"2024","unstructured":"Pollack S, Plonsky-Toder M, Tibi R, Yakubov R, Libinson-Zebegret I, Magen D (2024) Protocolized polyoma BK viral load monitoring and high-dose immunoglobulin treatment in children after kidney transplant. Clin Kidney J 17:sfad293. https:\/\/doi.org\/10.1093\/ckj\/sfad293","journal-title":"Clin Kidney J"},{"key":"7231_CR17","doi-asserted-by":"publisher","first-page":"3265","DOI":"10.1016\/j.ekir.2024.08.025","volume":"9","author":"M Baghai Arassi","year":"2024","unstructured":"Baghai Arassi M, Fei\u00dft M, Krupka K, Awan A, Benetti E, D\u00fczova A, Guzzo I, Kim JJ, Kranz B, Litwin M, Oh J, B\u00fcscher A, Pape L, Peruzzi L, Shenoy M, Testa S, Weber LT, Zieg J, H\u00f6cker B, Fichtner A, T\u00f6nshoff B, Cooperative European Pediatric Renal Transplant Initiative Research Network (2024) Age-Related differences in rejection rates, infections, and tacrolimus exposure in pediatric kidney transplant recipients in the CERTAIN registry. Kidney Int Rep 9:3265\u20133277. https:\/\/doi.org\/10.1016\/j.ekir.2024.08.025","journal-title":"Kidney Int Rep"},{"key":"7231_CR18","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.595297","volume":"11","author":"EC Semmes","year":"2021","unstructured":"Semmes EC, Chen J-L, Goswami R, Burt TD, Permar SR, Fouda GG (2021) Understanding early-life adaptive immunity to guide interventions for pediatric health. Front Immunol 11:595297. https:\/\/doi.org\/10.3389\/fimmu.2020.595297","journal-title":"Front Immunol"},{"key":"7231_CR19","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.coisb.2020.10.004","volume":"24","author":"J Tr\u00fcck","year":"2020","unstructured":"Tr\u00fcck J, Van Der Burg M (2020) Development of adaptive immune cells and receptor repertoires from infancy to adulthood. Curr Opin Syst Biol 24:51\u201355. https:\/\/doi.org\/10.1016\/j.coisb.2020.10.004","journal-title":"Curr Opin Syst Biol"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07231-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-026-07231-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07231-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:06:21Z","timestamp":1785452781000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00467-026-07231-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["7231"],"URL":"https:\/\/doi.org\/10.1007\/s00467-026-07231-8","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"assertion":[{"value":"11 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with ethical standards and received approval from the Institutional Review Board (IRB) of Rambam Health Care Campus (IRB Number: 0254-24).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}