Improvement in long-term graft survival in cadaveric renal transplant recipients treated with mycophenolate mofetil

Abstract

Though mycophenolate mofetil has markedly reduced the incidence of acute rejection in renal transplantation, a significant improvement in graft survival has been more difficult to demonstrate. This retrospective study compares an historical control group of 210 consecutive renal transplant patients, who had received ATG induction associated with cyclosporin, prednisolone and azathioprine, with 187 patients receiving mycophenolate instead of azathioprine. The incidence of acute rejection was decreased with mycophenolate. In rejection-free patients, the 3-year graft survival rates were equivalent. In contrast, graft survival at 3 years improved significantly for patients who experienced a rejection crisis and remained under the initial triple drug regimen with mycophenolate compared to the patients of the historical group who were kept on azathioprine after a rejection episode. In conclusion, mycophenolate mofetil is not only able to reduce the incidence of acute rejection but could also improve the prognostic significance of acute rejection crises.

Successful rescue therapy with mycophenolate mofetil in kidney transplantation improves the long-term graft survival

“…According to our results, switching from AZA to MMF as rescue therapy after acute rejection can avoid the negative impact of rejection on long-term graft survival. This is consistent with previous studies where MMF in addition to reducing the acute rejection rate also improved the prognostic significance of these rejection episodes (13). One of the possible mechanisms may be that MMF prevents development of chronic allograft nephropathy independent of acute rejections.…”

Mycophenolic acid clinical pharmacokinetics influenced by a cyclosporine C2 based immunosuppressive regimen in renal allograft recipients

“…Post‐transplant changes in renal function, hepatic metabolism, enterohepatic recycling, albumin levels, concomitant medication as well as variations in hepatic uridinediphosphate glucuronosyl transferase (UGT) expression lead to the highly variable pharmacokinetics reported in a number of studies [4–8]. Several studies have addressed the correlation between MPA concentrations and clinical outcome in renal transplantation and shown that MPA concentrations correlate with acute rejections [9–11]. However, trough MPA has shown to be of poorer predictive value than MPA AUC [11,12].…”