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Uncomplicated renal transplant receiving mycophenolate — DFSRH MCQ

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EasyOrgan TransplantUncomplicated renal transplant receiving mycophenolateDFSRH

A 32-year-old woman received a renal transplant 2 years ago. Graft function is stable, with no history of rejection or other transplant complication. She takes tacrolimus and mycophenolate mofetil. A palpable etonogestrel implant was inserted 10 months ago, and she takes no enzyme-inducing medication. She is sexually active, does not wish to conceive and asks whether mycophenolate means that she must change contraception or use condoms in addition to the implant. Which is the most appropriate advice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Continue the implant; one reliable contraceptive method is required during treatment and for 6 weeks after stopping, with a second method preferred

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

Mycophenolate is a potent human teratogen, so pregnancy must be avoided. Current UK prescribing information requires women of childbearing potential to use at least one reliable contraceptive method before and during treatment and for 6 weeks after stopping; two complementary methods are preferred, but are not mandatory. Her correctly sited etonogestrel implant is a highly effective, user-independent method and does not require replacement merely because she takes mycophenolate. An uncomplicated organ transplant is UKMEC 2 for implant use, meaning that its advantages generally outweigh theoretical or proven risks. A applies the 90-day precaution used for male patients taking mycophenolate or their female partners, rather than the 6-week interval for a woman taking it herself. B is incorrect because mycophenolate is not identified as an enzyme inducer that compromises implant efficacy; replacing the same method would not address an enzyme-inducing interaction in any event. C reflects older, more restrictive dual-method advice, but current UK product information requires one reliable method and states that two are preferred. E is incorrect because hormonal contraception is not contraindicated solely by an uncomplicated transplant; both the implant and copper IUD are UKMEC 2, so there is no indication to remove a satisfactory implant.

Reference: UK Medical Eligibility Criteria for Contraceptive Use (2016) — https://www.fsrh.org/Common/Uploaded%20files/Standards-and-Guidance/fsrh-ukmec-full-book-2019.pdf Mycophenolate Mofetil 500 mg film-coated tablets — Summary of Product Characteristics (22 May 2026) — https://www.medicines.org.uk/emc/product/101918/smpc Nexplanon 68 mg implant for subdermal use — Summary of Product Characteristics (15 May 2026) — https://www.medicines.org.uk/emc/product/5720/smpc