title: Mycophenolate mofetil reduces deterioration of renal function in patients with chronic allograft nephropathy. A follow-up study by the Spanish Cooperative Study Group of Chronic Allograft Nephropathy.
abstract: BACKGROUND
  Although studies have shown that mycophenolate mofetil (MMF) with cyclosporine (CsA) and prednisone can reduce the incidence of acute rejection and increase the half-life of the graft, the effects of MMF on established chronic allograft nephropathy (CAN) are controversial.
  
  
  METHODS
  We studied 121 patients with biopsy-proven CAN, 59 treated with CsA and prednisone and 62 treated with triple-drug therapy with azathioprine. At inclusion, each group received 2 g per day of MMF and azathioprine was stopped. Renal function was measured by the glomerular filtration rate (GFR) obtained by creatinine clearance (Cockcroft-Gault) and monitored by the slope of the GFR, adjusted using linear regression.
  
  
  RESULTS
  The median follow-up, after incorporation of MMF, was 36 (13-36) months, with 103 (85.1%) having a full 3-year follow-up. Before the introduction of MMF, there was progressive deterioration in renal function (GFR: 54.8+/-20.9 vs. 39.7+/-14.0 mL/min, P<0.001). After introduction of MMF, renal function remained stable (GFR: 39.7+/-14.0 vs. 41.3+/-10.8 mL/min, P=NS), with a significant change in the slope of the GFR (-0.0144 vs. +0.00045, P<0.001). In 65 patients in whom CsA blood levels remained unchanged during follow-up (148.0+/-65.6 vs. 154.1+/-58.2, P=NS), the slope of the GFR showed a reduction in loss of renal function (-0.0147 vs. -0.0001, P<0.001).
  
  
  CONCLUSIONS
  Treatment with MMF reduced the progressive deterioration of renal function in patients with CAN, independently of the blood levels of CsA.
authors.affiliation: Division of Nephrology, Hospital Universitario Carlos Haya, Malaga, Spain. cotraspa.hch.sspa@juntadeandalucia.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Gonzalez Molina
authors.forename: Daniel
authors.initials: D
authors.lastname: Seron
authors.forename: Raimundo
authors.initials: R
authors.lastname: Garcia del Moral
authors.forename: Marta
authors.initials: M
authors.lastname: Carrera
authors.forename: Eugenia
authors.initials: E
authors.lastname: Sola
authors.forename: Maria
authors.initials: M
authors.lastname: Jesus Alferez
authors.forename: Pablo
authors.initials: P
authors.lastname: Gomez Ullate
authors.forename: Luis
authors.initials: L
authors.lastname: Capdevila
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gentil
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003404:Creatinine / Q000378:metabolism; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000276:immunology* / Q000517:prevention & control; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine; D003404:Creatinine; D009173:Mycophenolic Acid; D001379:Azathioprine