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Background: In Scotland, standard maintenance immunosuppression following kidney transplantation consists of mycophenolate (MPA), tacrolimus and prednisolone irrespective of recipient age. We analyzed the tolerability of this immunosuppression regimen and the association with transplant outcomes., Methods: A national, multicentre retrospective analysis of patients transplanted in 2015 and 2016, comparing graft function, acute rejection, significant infection rates and immunosuppression dosing between patients aged 18 and 59 years (Group 1) and ≥60 years (Group 2)., Results: Of the 490 patients, 26% were aged ≥60 years. Acute rejection (AR) rates at 1 year were 15% and 11% in Groups 1 and 2, respectively. Full-dose MPA was poorly tolerated with 53% in Group 1 and 77% in Group 2 requiring dose reduction or cessation. Female gender and age ≥60 years were independent predictors for MPA dose changes. One year following MPA dose reduction, AR risk was low (5%) in Group 2, however, those remaining on full dose MPA had a 79% increased rate of serious infections., Conclusion: The majority of renal transplant recipients aged ≥60 fail to tolerate full-dose MPA. In this group, MPA dose reduction is associated with low rejection rates, but full-dose MPA is associated with high infection rates. We suggest that a tailored approach to immunosuppression in elderly recipients incorporating lower doses of MPA may be appropriate., (© 2020 Asian Pacific Society of Nephrology.)

The Cochrane Collaboration is a global network whose aim is to improve health-care decision making through systematic reviews of the effects of health-care interventions. Cochrane systematic reviews are published in the Cochrane Database of Systematic Reviews within The Cochrane Library ( http://www.thecochranelibrary.com), and regularly updated as new evidence arises. Cochrane Reviews are undertaken by teams of volunteer authors, who have access to free training resources, reference texts and software for preparing and maintaining their review. Here we aim to describe the steps involved to undertake a new or update an existing Cochrane Review., (© 2010 The Authors. Nephrology © 2010 Asian Pacific Society of Nephrology.)