Efficacy of low-dose mycophenolate mofetil therapy for Taiwanese renal transplantation patients receiving primary cyclosporine immunosuppression.
OBJECTIVE
Mycophenolate mofetil (MMF) in combination with cyclosporine or tacrolimus prevents acute rejection and chronic allograft failure in renal transplantation in Western countries. We began to add low-dose MMF to primary cyclosporine immunosuppressive therapy in renal transplantation at the Department of Surgery of National Taiwan University Hospital in 1998. This study compared low-dose MMF to conventional therapy in Taiwanese renal transplant recipients.


METHODS
This retrospective cohort study determined the efficacy of low-dose MMF therapy (1 g/day in divided doses). A total of 275 cases with allograft kidney transplants were grouped according to whether they received transplants before or after the adoption of MMF therapy (Period I: 1987-1993; Period II: 1994-1997; Period III: 1998-September 2000). The prognostic significance of MMF therapy and graft and patient survival rate in each time period were assessed.


RESULTS
The 18-month graft survival rate was 84.9% in Period I, 86.3% in Period II, and 91.9% in Period III. The 5-year graft survival rates in Periods I and II were 69.3% and 76.6%, respectively. Acute rejection was significantly detrimental to graft survival (p = 0.048), while MMF therapy was significantly advantageous to graft survival (p = 0.015); treatment when MMF was available was also significantly associated with better graft survival (p = 0.043). There was a negative correlation between acute rejection and graft survival (p = 0.035); MMF therapy produced a protective effect on graft survival independent of acute rejection (p = 0.010).


CONCLUSIONS
Low-dose MMF therapy significantly improved graft survival after renal transplantation in Taiwanese kidney allograft recipients.
Tsai
Meng-Kun
MK
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Hu
Rey-Heng
RH
Lee
Chun-Jean
CJ
Lee
Po-Huang
PH
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid