{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T08:18:33Z","timestamp":1781770713622,"version":"3.54.5"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mycophenolate Mofetil (MMF) is an effective immunosuppressant used in kidney transplant recipients to prevent acute rejection. Complications such as diarrhea, leukopenia, and infections may necessitate the reduction or discontinuation of MMF. The objective of the study was to investigate the prevalence, timing, and reasons for MMF discontinuation and its association with outcomes in pediatric kidney transplant recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven Pediatric Nephrology Research Consortium (PNRC) centers participated in a retrospective analysis of kidney transplant recipients &lt;21\u2009years of age. Characteristics and outcomes of patients in whom MMF was discontinued were compared to those who continued taking MMF throughout the first 2\u2009years post\u2010transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study population included 288 participants (mean age 11.2\u2009years) from 7 North American transplant centers. MMF was discontinued in 93\/288 (32%) of participants. Common reasons for discontinuation included infections (35%), diarrhea (32%), leukopenia (15%), and others (18%). Increased cumulative alloimmunity (55% vs. 42%, <jats:italic>p<\/jats:italic>\u2009=\u2009.02), increased number of hospitalizations (82% vs. 67%, <jats:italic>p<\/jats:italic>\u2009=\u2009.01), and viral replications (79% vs. 47%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) were observed in the MMF discontinuation group compared to the continuation group. Greater eGFR decline also occurred in the MMF discontinuation group over 2\u2009years of follow\u2010up (\u22127 vs. \u22121\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009=\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Almost a third of pediatric kidney transplant recipients who begin MMF for maintenance immunosuppression have it discontinued within the first 2\u2009years post\u2010transplant, and this subset of patients is more likely to experience adverse outcomes. New strategies are needed to manage MMF therapy and improve post\u2010transplant outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14628","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T09:04:05Z","timestamp":1698224645000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9376-6659","authenticated-orcid":false,"given":"Asha","family":"Moudgil","sequence":"first","affiliation":[{"name":"Nephrology Children's National Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0795-3210","authenticated-orcid":false,"given":"Kristen","family":"Sgambat","sequence":"additional","affiliation":[{"name":"Nephrology Children's National Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Benoit","sequence":"additional","affiliation":[{"name":"Nephrology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0557-6178","authenticated-orcid":false,"given":"Michael E.","family":"Seifert","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology The University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhumithaa","family":"Bharadwaj","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology and Hypertension Children's Hospital of Michigan  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrish","family":"Jain","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology and Hypertension Children's Hospital of Michigan  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Mansuri","sequence":"additional","affiliation":[{"name":"Nephrology Children's Hospital of Georgia  Augusta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyndsay","family":"Harshman","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology University of Iowa Stead Family Children's Hospital  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chryso","family":"Katsoufis","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Holtz Children's Hospital\/Jackson Memorial Hospital  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Somers","sequence":"additional","affiliation":[{"name":"Nephrology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(98)00244-9"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/14.2.394"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0012.2003.00026.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000079616.71891.F5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2008.00892.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199307000-00013"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(18)30747-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2011.01.184"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01640309"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-4-200608150-00004"},{"issue":"1","key":"e_1_2_7_12_1","first-page":"p76","article-title":"Non\u2010protocol immunosuppression changes during the first year after kidney transplantation","volume":"21","author":"Cook C","year":"2017","journal-title":"Pediatr Transplant"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2005.00261.x"}],"container-title":["Pediatric 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