PURPOSE: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transplant patients. However, it is expensive and cannot be used routinely in our population. MATERIAL AND METHODS: In a retrospective study, 60 renal transplant patients on MMF based triple immunosuppression were analysed. The indication for MMF was as rescue therapy after treatment of acute vascular rejection (Banff type-4, grade IIA, IIB and III) in all patients. However, 20 such patients also had associated chronic liver diseases. The patients were given 1.5-2.0 g MMF in two divided doses at least for 6 months, depending upon the tolerability, adverse effects and affordability, and followed-up at least for 1 year. The control group consisted of 60 cases of acute vascular rejection (Banff type-4, grade IIA, IIB and III) who were placed on cyclosporine, azathioprine and steroid based maintenance immunosuppressive regimen in same time frame. RESULTS: The incidence recurrent acute rejections in MMF group was 18% and 42% in control group (P < 0.005). The serum transaminases in all patients of the liver diseases became normal in 3-6 months. The incidence of opportunistic infections in MMF and control group were 22% and 11% respectively (P < 0.05). The MMF based regimen was two times more expensive. The 1 year patient and graft survivals between two groups were not statistically significantly different. CONCLUSION: The MMF based regimen significantly decreases the recurrent acute rejections. However, it is expensive and cannot be used routinely in all patients in Indian scenario.
PURPOSE:Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transplant patients. However, it is expensive and cannot be used routinely in our population. MATERIAL AND METHODS: In a retrospective study, 60 renal transplant patients on MMF based triple immunosuppression were analysed. The indication for MMF was as rescue therapy after treatment of acute vascular rejection (Banff type-4, grade IIA, IIB and III) in all patients. However, 20 such patients also had associated chronic liver diseases. The patients were given 1.5-2.0 g MMF in two divided doses at least for 6 months, depending upon the tolerability, adverse effects and affordability, and followed-up at least for 1 year. The control group consisted of 60 cases of acute vascular rejection (Banff type-4, grade IIA, IIB and III) who were placed on cyclosporine, azathioprine and steroid based maintenance immunosuppressive regimen in same time frame. RESULTS: The incidence recurrent acute rejections in MMF group was 18% and 42% in control group (P < 0.005). The serum transaminases in all patients of the liver diseases became normal in 3-6 months. The incidence of opportunistic infections in MMF and control group were 22% and 11% respectively (P < 0.05). The MMF based regimen was two times more expensive. The 1 year patient and graft survivals between two groups were not statistically significantly different. CONCLUSION: The MMF based regimen significantly decreases the recurrent acute rejections. However, it is expensive and cannot be used routinely in all patients in Indian scenario.
Authors: David W Johnson; David L Nicol; David M Purdie; John M Preston; Allison M Brown; Carmel M Hawley; Scott B Campbell; Darryl Wall; Anthony D Griffin; Nicole M Isbel Journal: Transplantation Date: 2002-04-15 Impact factor: 4.939
Authors: A O Ojo; H U Meier-Kriesche; J A Hanson; A B Leichtman; D Cibrik; J C Magee; R A Wolfe; L Y Agodoa; B Kaplan Journal: Transplantation Date: 2000-06-15 Impact factor: 4.939