Biomarker-Guided Mycophenolate Mofetil Elimination in Low-Risk Older Adult Kidney Transplant Recipients

To evaluate the feasibility, safety, protocol adherence, biomarker monitoring completion,and preliminary clinical event rates associated with stepwise MMF elimination over 6months compared with standard‐of‐care immunosuppression in low‐risk older adult kidneytransplant recipients.Secondary objectives. To compare between arms: eGFR trajectory and proteinuria at Months6 and 12; infection incidence (including CMV and BK), hospitalization, and adverse drugevents; de novo DSA incidence and time to de novo DSA; and the kinetics and predictiveperformance of dd‐cfDNA and urine CXCL9 and CXCL10 for rejection and de novo DSA.Exploratory objectives. To assess the association between PIRCHE‐II score and individualprimary endpoint components; the performance of combined biomarker panels versus singlebiomarkers; health‐related quality of life and patient‐reported outcomes through Month12; and cost and healthcare resource utilization through Month 12 across study arms.