Effect of mycophenolate mofetil regimen on peripheral blood lymphocyte subsets in kidney transplant recipients.
OBJECTIVE
There is growing evidence of the effects of immunosuppressive agents on "immune targets" in renal transplantation. Immunological monitoring could indirectly measure the suppressive effect of these drugs and guide early preventive interventions in transplant recipients. Due to the selective antiproliferative effect of mycophenolate mofetil (MMF) on lymphocytes, our goal was to determine whether MMF modulates peripheral blood lymphocyte subsets (PBLS) in kidney allograft patients.


METHODS
We assessed absolute CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD19(+), CD16(+)CD3(-) PBLS counts and CD4/CD8 ratios for 12 months in three groups of kidney allograft patients stratified according to maintenance immunosuppressive regimen: group A (n = 31), which started MMF with prednisone (P) + cyclosporine A (CyA), and two control groups, B (n = 19) and C (n = 15) on P + CyA + azathioprine (Aza) and P + CyA regimens, respectively. We compared intra- and intergroup lymphocyte counts and ratios.


RESULTS
Intergroup comparisons showed a significant reduction in all PBLS in group A (CD19(+) from 3 months and other subsets from 6 months), whereas there were no significant changes in PBLS in the other group analyses or comparisons.


CONCLUSIONS
Our findings suggest that (1) MMF modulates all PBLS in kidney allograft patients, causing a progressive reduction occurring earlier in CD19(+), and (2) we can rule out that these changes were caused by the "natural immunological evolution" of the transplantation. These results could offer a new method for immunological monitoring of transplant patients.
Bravo Soto
J A
JA
Nephrology Services of Virgen de las Nieves University Hospital, Grenada, Spain.
Esteban de la Rosa
R J
RJ
Luna del Castillo
J D
JD
Cerezo Morales
S
S
García Olivares
E
E
Osuna Ortega
A
A
Asensio Peinado
C
C
D015703:Antigens, CD / Q000097:blood*; D001379:Azathioprine / Q000627:therapeutic use; D016516:CD4-CD8 Ratio; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D016131:Lymphocyte Subsets; D015166:Monitoring, Immunologic; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use
D015703:Antigens, CD; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone