ESPN 50th Annual Meeting

ESPN 2017


 
Converting immunosuppression from Prograf® to Modigraf® in paediatric renal transplant patients
GEORGIA MALAKASIOTI 1 CHRISTINE BOOTH 1 STEPHEN MARKS 1

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN, London, UK
 
Introduction:

Adherence to immunosuppression is of paramount importance for renal allograft recipients. In paediatric patients a granular formulation that allows flexibility for body weight-based dose adjustments is necessary. Our study aims at monitoring the impact of conversion from Prograf capsules to Modigraf granules in stable paediatric renal transplants.


Material and methods:

Renal allograft recipients  <18 years old followed up in our centre were eligible. Exclusion criteria were parental/patient preference to remain on Prograf, lactose intolerance and very low dose incompatible with measurement of the new granule formulation. Plasma creatinine and trough tacrolimus levels were obtained within 1 (Wk1) and 4-8 weeks post conversion (Wk4-8). Graft survival, side effects and creatinine levels were evaluated after 1 year.

Results:

Twenty-six patients were finally converted. Mean patient age was 8+/- 4.1 years. Pre-conversion 69.2% of patients had no rejection episodes, 26.9% had 1 and 1 patient had 2. Only 1 patient had 1 rejection episode 1 year post conversion. Rejection rates for patients 1 year or more post-transplant were 0.2+/-0.4 and 0.1+/-0.2 episodes per year pre and post change respectively (p=0.25). Graft survival at 12 months was 100% without any side effects. Trough tacrolimus and creatinine levels at D0, Wk1, Wk4-8 and 1 year did not differ (p>0.05). No change in Modigraf dose was necessary in 42.3% of individuals whereas  a 5-67% increase and a 7-25% decrease were implemented in 9 and 6 patients respectively. No statistical difference between number of dose changes at Wk1 and Wk4-8 was detected.

Conclusions:

Conversion from Prograf to Modigraf in stable renal allograft patients is safe and efficacious. Close monitoring is though necessary with additional patient visits in order to optimise medication dose.