Objectives: Mycophenolate mofetil(MMF) causes gastrointestinal adverse effects in 45% of kidney transplant recipients, as enterocytes are partially dependent on de-novo pathway of purine synthesis. The study aims to describe the outcomes of immunosuppression modification in symptomatic kidney transplant recipients having histopathological evidence of MMF-related toxicity. Methods: A retrospective observational study from January 2009 to December 2018 at Sanjay Gandhi Postgraduate Institute, Lucknow. All cases that had evidence of MMF-associated histopathological changes and underwent immunosuppression modification were included and studied. Results: Among 122 recipients who underwent endoscopic biopsy, MMF-associated histopathological changes were observed in 102(83.6%) cases. The indication of endoscopy was persistent or chronic diarrhea in 83.3%(n=85), and non-diarrheal causes in 16.7%(n=17) cases. The associated features were anemia(45.1%,n=46), weight loss(37.3%,n=38) and rectal bleed(6.9%,n=7). Mean duration was 58.15±52.34(1-274) months post-transplant. Mean creatinine was 1.84±0.91mg/dl. All patients were on a triple immunosuppressive regimen, with either mycophenolate mofetil(79.4%,n=81) or enteric-coated mycophenolate sodium(20.6%,n=21). The comorbidities included diabetes(40.2%,n=41), tuberculosis(26.5%,n=27), CMV infection(37.3%,n=38), prior antirejection therapy(33.3%,n=34), and chronic renal allograft injury(46.1%,n=47). 2 cases had coexisting post-transplant lymphoproliferative disorder. Despite conservative management and treatment of associated conditions, 61(59.8%) patients with persistent symptoms required immunosuppressive drug modification. MMF was changed to enteric-coated mycophenolate sodium(ECMPS) in 20(32.8%), Azathioprine in 25(41.0%), and mTOR inhibitors in 4(6.6%) cases, while MMF/ECMPS was discontinued completely in 12(19.7%) cases. Response was seen in 52(85.2%) patients. However, 18(29.5%) patients developed biopsy-proven rejection on drug modification. MMF was reintroduced in 6 patients, but 2 patients had diarrhea recurrence. During a mean follow-up period of 57.5 months, 18 patients had CRAI including 8 graft losses, 17 patients died, and 19 patients were lost to follow-up. Conclusions: GI toxicity related to mycophenolate therapy is fairly prevalent in kidney transplant recipients. The severe symptomatic cases require immunosuppression modification, which can result in an increased risk of rejection and de-novo DSA formation.