Selective use of mycophenolate mofetil in renal transplant patients in Indian scenario.
OBJECTIVE
Although mycophenolate mofetil (MMF) has emerged as a valuable immunosuppressive in renal transplantation, its high cost demands that it be used selectively.


METHODS
This retrospectively study included 55 renal transplant patients on MMF for rescue therapy after treatment of acute vascular rejection (n = 45), acute/chronic liver disease with elevated transaminases (n = 4), early chronic rejection (n = 2), cyclosporine toxicity (n = 3), and cyclosporine-induced hemolytic-uremic syndrome (n = 1). The patients were given 1.5 to 2 g MMF in divided doses for at least 6 months, depending upon the tolerability, adverse effects, and finances, and followed for 1 year. The patients on MMF following treatment of acute rejections were compared with controls who received azathioprine-based triple immunosuppression after treatment of an acute rejection episode.


RESULTS
The incidence of recurrent acute rejection in the first year was 18% in the MMF group compared to 42% in the control group (P < .005). The serum transaminases in the acute/chronic liver disease group reached normal levels at 3 to 6 months. The serum creatinine remained stable for a mean duration of 8 months in the early chronic rejection patients. The patients with cyclosporine toxicity showed stable graft function on low-dose cyclosporine. The patient with hemolytic-uremic syndrome showed stable graft function for 4 years. The MMF-based triple regimen is two times more expensive than an azathioprine-based regimen.


CONCLUSIONS
MMF significantly decreases the recurrence of acute rejection. It is a good alternative agent in special situations like acute/chronic liver diseases with elevated transaminases, early chronic rejection, cyclosporine toxicity, and cyclosporine-induced hemolytic-uremic syndrome. Because of the high cost it should be used selectively in our population.
Srivastava
A
A
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. aneesh@sgpgi.ac.in
Singh
V
V
Kumar
A
A
Sharma
R K
RK
Gupta
A
A
D000208:Acute Disease; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006085:Graft Survival; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007194:India; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid