The Effectiveness of Mycophenolate Mofetil(MMF) in the Prevention of Acute Rejection and Graft Outcome in Clinical Renal Transplantation

Lee, Byung Jin; Kwon, Oh Jung; Lee, Kwang Soo; Kang, Chong Myung; Kwak, Jin Young

Abstract

In this study, We evaluated the safety and efficacy of mycophenolate mofetil (MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the postoperative period in living donor kidney transplantation. 212 patients were enrolled; 106 patients received triple therapy with azathioprine (control group) and another 106 patients received triple regimen with MMF 2 g/day (study group). There was two subgroup in the study group. Of the study group, one subgroup was 90 patients treated MMF after acute rejection episode or an increase in serum creatinine level above 2.0 mg/dl (MMF conversion) and another group was 16 patients with primary MMF therapy. We made no demographic difference between study and control groups with patient selection for reducing bias. There was no statistical differences in serum creatinine level between two groups at 2 years after transplantation. There were 12 (13.3%), 3 (18.8%) acute rejection episodes in the MMF conversion and primary MMF therapy groups and 36 (33.7%) in the control group with statistic difference (p=0.01). 5 patients (5.6%) in the MMF-treated group lost their graft versus 16 patiens (15%) in the AZA-treated group. The 2-year graft survival rate was 97.4% in the study group and 83.9% in the control group. There was signficant difference in 2-year graft survival (p=0.003). The adverse effects of MMF were opportunistic infection, leukopenia, abdominal pain and diarrhea. MMF in combination with cyclosporine and prednisone was superior to a standard immunosuppressive regimen including azathioprine. Taken together, the data indicated that MMF will be a valuable addition to the list of immunosuppressants available for the prevention and treatment of acute renal rejection after renal transplantation. Its final place in clinical transplantation will be determined by further analysis of future, randomized-prospective studies, and by broadening experience with this important addition to the immunosuppressive regimen.