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.
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.
Gonzalez Molina
Miguel
M
Division of Nephrology, Hospital Universitario Carlos Haya, Malaga, Spain. cotraspa.hch.sspa@juntadeandalucia.es
Seron
Daniel
D
Garcia del Moral
Raimundo
R
Carrera
Marta
M
Sola
Eugenia
E
Jesus Alferez
Maria
M
Gomez Ullate
Pablo
P
Capdevila
Luis
L
Gentil
Miguel A
MA
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
D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine; D003404:Creatinine; D009173:Mycophenolic Acid; D001379:Azathioprine