Mycophenolate mofetil dosage modifications following gastrointestinal complications in renal transplant patients.

Evaluation of: Machnicki G, Ricci JF, Brennan DC, Schnitzler MA. Economic impact and long-term graft outcomes of mycophenolate mofetil dosage modifications following gastrointestinal complications in renal transplant recipients. Pharmacoeconomics 26(11), 951-967 (2008). This commentary discusses findings from an observational study designed to determine the 3-year clinical and economic impact of dose reduction or discontinuation of mycophenolate mofetil after the first gastrointestinal complication in patients after kidney transplantation. The authors used data from the US Renal Data System to demonstrate that dosage reduction or discontinuation of mycophenolate mofetil in the first 6 months after diagnosis of gastrointestinal complications is associated with a significantly increased risk of graft failure and increased healthcare costs in adult renal transplant recipients. This article highlights the clinical significance as well as some of the shortcomings of the authors' findings. The introduction of mycophenolate mofetil has clearly improved renal transplant outcomes; however, there is a need for well-planned studies examining pharmacokinetics and pharmacodynamics of mycophenolate mofetil and strategies for reducing gastrointestinal side effects.