High-dose mycophenolate mofetil in the treatment of posttransplant glomerular disease in the allograft: a case series.
BACKGROUND
Glomerular disease is an important cause of allograft loss. Treatment regimens for posttransplant glomerular disease are not well defined. Several reports have demonstrated that mycophenolate mofetil (MMF) is effective in treating native kidney glomerular disease. The effects of MMF are dose related. Therefore, we hypothesized that high-dose MMF (3 g/day) would be effective in treating glomerular disease in the allograft, minimizing the need for intravenous steroids and/or cyclophosphamide. This case series describes the results of the use of high-dose MMF in 6 patients.


METHODS
High-dose MMF (3 g/day) was used to treat biopsy-proven glomerular disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, proliferative lupus nephritis, and perinuclear antineutrophil cytoplasmic antibodies glomerulonephritis) in 6 renal transplant recipients. Patients were offered this treatment if they had failed or did not tolerate standard treatment regimens. Remission was defined by a decrease or stabilization of serum creatinine, decrease in proteinuria and, where applicable, improvement in immunological markers of disease.


RESULTS
All 6 patients had disease remission after starting MMF with the most common side effect being leukopenia, which responded to dose reduction.


CONCLUSIONS
High-dose MMF may be an effective agent in treating glomerular disease in the allograft.
Wu
Jean
J
Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md, USA. jeanwu@jhmi.edu
Jaar
Bernard G
BG
Briggs
William A
WA
Choi
Michael J
MJ
Kraus
Edward S
ES
Racusen
Lorraine C
LC
Atta
Mohamed G
MG
Samaniego
Milagros D
MD
D000328:Adult; D000368:Aged; D005260:Female; D005921:Glomerulonephritis; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000209:etiology; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012074:Remission Induction
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid