Prophylaxis with Mycophenolate Mofetil to Reduce Acute Rejection in Renal Transplantation?

Allograft rejection remains an important cause of graft loss in Cyclosporine-treated (CyA) renal transplant recipients (RTX). In combination with CyA and corticosteroids (Pred), Mycophenolate Mofetil, (MMF), has been shown to significantly reduce incidence of early acute rejection (AR) from 38% to 19%. Nevertheless, there has been no difference in graft survival up to 3 years post RTX, thus the benefits of extending MMF therapy to beyond 6 months post RTX have not been established. The present study was designed to examine the efficacy of a 6 month course of MMF in prophylaxis of AR in an Asian RTX population. Forty patients undergoing primary cadaveric RTX with CyA-Pred immunosuppression from April 1997 to January 1999 were randomized to receive MMF 2g/day or AZA 1 mg/kg/day for 6 months in an open label format. Demographics of MMF and AZA groups at entry were comparable. One patient in the MMF and two in the AZA group were withdrawn from the drugs for cytomegalovirus pneumonia and refractory rejection respectively. By intent to treat analysis, the incidence of AR by 6 months post RTX was lower in the MMF group (10%, vs. 35%, MMF vs. AZA; P=0.06). Secondary endpoints at 6 months, i.e. graft and patient survivals (100% for both groups), adverse effects and treatment failure were also comparable between the two groups. At the end of 6 months, MMF patients were converted to AZA and all patients followed up for 1 year post RTX. Following conversion, 2 of 20 (10%) converted patients had a biopsy-proven AR episode within 2 months after conversion, while none of the AZA patients underwent AR episode beyond 6 months post RTX. On comparison of various parameters predicting AR after conversion, serum creatinine (SCr) and 24 hour proteinuria (TUP) at 6 months post RTX, prior to conversion, were significantly higher in rejecting patients (SCr 204 ± 4vs. 130 ± 40 mol/L, P=0.02;TUP 0.35 ± 0.5vs.0.06 ± 0.14,P=0.04 rejecting vs. non rejecting patients). These results suggest that though a 6 month course of MMF is efficacious in reducing early AR in RTX, AR after conversion at 6 months from MMF to AZA may occur, thus reducing the benefits of MMF. Further trials are necessary to determine if extending MMF to 1 year post RTX is effective for prophylaxis of AR post RTX.

並列關鍵字

mycophenolate mofetil ； renal transplantation ； reduce acute rejection

國際替代計量

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