{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:50:24Z","timestamp":1761630624243},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,8,2]],"date-time":"2012-08-02T00:00:00Z","timestamp":1343865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Prospective data are lacking concerning the effect of reduced mycophenolic acid (<jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content>) dosing on efficacy and the influence of concomitant tacrolimus exposure. The <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ycophenolic <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>enal <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>ransplant (<jats:styled-content style=\"fixed-case\">MORE<\/jats:styled-content>) <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>egistry is a prospective, observational study of de novo kidney transplant patients receiving <jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content> therapy under routine management. The effect of <jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content> dose reduction, interruption, or discontinuation (dose changes) was assessed in 870 tacrolimus\u2010treated patients: 375 (43.1%) reduced tacrolimus (\u22647\u00a0ng\/mL at baseline) and 495 (56.9%) standard tacrolimus (&gt;7\u00a0ng\/mL); enteric\u2010coated mycophenolate sodium 589 (67.7%) and mycophenolate mofetil 281 (32.3%). During baseline to month 1, months 1\u20133, months 3\u20136, and months 6\u201312, 9.3% (78\/838), 16.6% (132\/794), 20.7% (145\/701), and 13.1% (70\/535) patients, respectively, required <jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content> dose changes. These patients experienced an increased risk of biopsy\u2010proven acute rejection at one\u00a0yr with tacrolimus exposure either included in the model (hazard ratio [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>] 2.60, 95% CI 1.28\u20135.29, p<jats:italic>\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.008) or excluded (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.58, 95%\u00a0CI 1.28\u20135.23, p<jats:italic>\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.008). <jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content> dose changes were significantly associated with one\u00a0yr graft failure when tacrolimus exposure was included (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.23; 95% CI 1.01\u20134.89, p<jats:italic>\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.047) but not when tacrolimus exposure was excluded (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.16; 95% CI 0.99\u20134.79; p<jats:italic>\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.054). These results suggest that reducing or discontinuing <jats:styled-content style=\"fixed-case\">MPA<\/jats:styled-content> can adversely affect graft outcomes regardless of tacrolimus trough levels.<\/jats:p>","DOI":"10.1111\/j.1399-0012.2012.01694.x","type":"journal-article","created":{"date-parts":[[2012,8,3]],"date-time":"2012-08-03T17:39:02Z","timestamp":1344015542000},"page":"15-24","source":"Crossref","is-referenced-by-count":21,"title":["Does reduction in mycophenolic acid dose compromise efficacy regardless of tacrolimus exposure level? An analysis of prospective data from the <scp>M<\/scp>ycophenolic <scp>R<\/scp>enal <scp>T<\/scp>ransplant (<scp>MORE<\/scp>) <scp>R<\/scp>egistry"],"prefix":"10.1111","volume":"27","author":[{"given":"Anthony","family":"Langone","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cataldo","family":"Doria","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Hospital Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Greenstein","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohanram","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Scott and White Memorial Hospital Temple TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimi","family":"Ueda","sequence":"additional","affiliation":[{"name":"California Pacific Medical Center San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bashir","family":"Sankari","sequence":"additional","affiliation":[{"name":"Charleston Area Medical Center Charleston WV USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oleh","family":"Pankewycz","sequence":"additional","affiliation":[{"name":"State University of New York at Buffalo Buffalo NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuad","family":"Shihab","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine Salt Lake City UT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence","family":"Chan","sequence":"additional","affiliation":[{"name":"University of Colorado Medical Center Denver CO 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