Abstract

Development for chronic lung allograft dysfunction (CLAD) is a limiting factor for post-lung transplant survival. We evaluated, whether the dose of the immunosuppressant mycophenolate mofetil (MMF) or the active metabolite of MMF, mycophenolic acid (MPA) plasma concentrations, affect the development of CLAD in patients with lung transplantation.

In this retrospective, controlled cohort study we recruited 71 patients with a lung transplantation between 2010 and 2014 who provided a consent and did not develop complications within a year after transplantation. The observation period ranged to July 01, 2021. An event-time-analytical Cox proportional-hazards regression model with time-dependent covariates was used to estimate the association of MMF dose, MPA plasma concentrations and CLAD, with adjustment for sociodemographic factors and coexisting conditions.

37 patients did not develop CLAD (41.3±15.6 years, FEV1 95.5±19.1% predicted) and 34 patients developed CLAD (age 50.9±13.3 years, FEV1 102.2±25.4% predicted). While there was a dose-effect relationship between MMF dosage, plasma MPA concentrations, as well as lymphocyte levels, traditional risk factors (age, lung-function, radiological features) predicted CLAD. Continuously measured MPA plasma concentration did not predict CLAD (period of 382.97 patient-years) nor death (period of 472.8 patient-years).

MMF dosage and MPA plasma concentration were not associated with CLAD development or death.