Effect of mycophenolate mofetil on progression of interstitial fibrosis and tubular atrophy after kidney transplantation: a retrospective study

Abstract

ObjectivesChronic transplant dysfunction after kidney transplantation is a major reason of kidney graft loss and is caused by immunological and non-immunological factors. There is evidence that mycophenolate mofetil (MMF) may exert a positive effect on renal damage in addition to immunosuppression, by its direct antifibrotic properties. The aim of our study was to retrospectively investigate the role of MMF doses on progression of chronic allograft dysfunction and fibrosis and tubular atrophy (IF/TA).SettingRetrospective, cohort study.ParticipantsPatients with kidney transplant in a tertiary care institution. This is a retrospective cohort study that included 79 patients with kidney and kidney–pancreas transplantation. Immunosuppression consisted of anti-interleukin 2 antibody induction, MMF, a calcineurin inhibitor±steroids.Primary outcome measuresAn association of average MMF doses over 1 year post-transplant with progression of interstitial fibrosis (Δci), tubular atrophy (Δct) and estimated-creatinine clearance (eCrcl) at 1 year post-transplant was evaluated using univariate and multivariate analyses.ResultsA higher average MMF dose was significantly independently associated with better eCrcl at 1 year post-transplant (b=0.21±0.1, p=0.04). In multiple regression analysis lower Δci (b=−0.2±0.09, p=0.05) and Δct (b=−0.29±0.1, p=0.02) were independently associated with a greater average MMF dose. There was no correlation between average MMF doses and incidence of acute rejection (p=0.68).ConclusionsA higher average MMF dose over 1 year is associated with better renal function and slower progression of IF/TA, at least partly independent of its immunosuppressive effects.

Incidence Rate and Predictors of Delayed Graft Function Among Adult Kidney Transplant Recipients at a Tertiary Care Hospital in Riyadh, Saudi Arabia

“…The immunosuppressive regimen given to patients at KAMC may have a role in this reduced rate. It is worth mentioning that in addition to MMF playing a major role in reducing DGF rates, there is evidence that it slows tubular atrophy progression and interstitial fibrosis [29], which are renal pathologies that significantly contribute to the development of ESRD.…”

Inflammation and renal fibrosis: Recent developments on key signaling molecules as potential therapeutic targets

“…Nakanishi and colleagues compared the antifibrotic effects of BMS-566419, a chemically synthesized IMPDH inhibitor, to MMF in the UUO rat model of renal fibrosis (Nakanishi et al, 2010). The results suggested that BMS-566419 and similar inhibitors have beneficial effects equivalent to MMF, and are potential therapeutic candidates for fibrotic renal disease (Mihovilovic et al, 2014; Morath et al, 2006; Nakanishi et al, 2010). Lastly, the active components of several traditional Chinese medicines with renal protective effects, such as celastrol, rhein, and danshensu, inhibit the NF-κB pathway (Guan et al, 2015; Kim et al, 2013).…”

Long-term health-related quality of life of living kidney donors: a single-center experience

“…''Are you anxious about your future?''). There are four different types of answers to the questions: dichotomous scale (23), multiple choice (9), open questions (6), and Likert scale (2).…”

“…Kidney transplantation has become a well-established method in the treatment of patients with end-stage renal failure and has led to an increased overall survival rate compared to patients on hemodialysis [1].The patient and graft survival have improved steadily due to better immunosuppressive regimens [2], improved surgical methods [3], and better anesthetic management [4].…”