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Renal transplantation requiring mycophenolate immunosuppression — DFSRH MCQ

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EasyRenal ImpairmentRenal transplantation requiring mycophenolate immunosuppressionDFSRH

A 33-year-old woman received a renal transplant 4 years ago. Her graft function is stable, and she uses an etonogestrel contraceptive implant inserted 2 years ago. She wishes to conceive. Following multidisciplinary preconception review, her transplant team has changed her maintenance immunosuppression from mycophenolate mofetil to azathioprine; she took her final mycophenolate dose today. She asks for immediate implant removal. Pregnancy is excluded, and the transplant team advises that the revised immunosuppressive regimen should otherwise be established before conception. When should the implant be removed, provided her transplant preconception plan remains satisfactory?

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

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Correct answer: D — Six weeks after the final mycophenolate dose

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

Mycophenolate is a major human teratogen associated with markedly increased risks of miscarriage and congenital malformation. A woman of reproductive potential must use at least one reliable contraceptive method throughout treatment and for 6 weeks after the final dose; two complementary methods are preferred during treatment. Retaining her existing implant maintains highly effective, user-independent contraception throughout the required post-treatment interval. It can therefore be removed after 6 weeks, once the transplant preconception plan remains satisfactory. A is incorrect because stopping mycophenolate does not end the pregnancy-prevention requirement immediately. C applies the 90-day precaution used for sexually active male patients or their female partners, not the interval for a woman who has taken mycophenolate herself. D may attract candidates familiar with repeating a pregnancy test 3 weeks after a potential conception risk or uncertain contraceptive initiation, but it is not the required mycophenolate washout interval. E is unnecessarily prolonged: some teratogenic medicines require longer avoidance periods, but the specified interval after maternal mycophenolate exposure is 6 weeks. The negative pregnancy assessment today excludes current pregnancy but does not protect a conception occurring during the post-treatment risk period.

Reference: Mycophenolate mofetil Tillomed 500 mg film-coated tablets — Summary of Product Characteristics (Text revised 15 April 2026) — https://www.medicines.org.uk/emc/product/11559/smpc Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men (Published 14 December 2015; updated advice February 2018 and post-publication note September 2021) — https://www.gov.uk/drug-safety-update/mycophenolate-mofetil-mycophenolic-acid-new-pregnancy-prevention-advice-for-women-and-men