title: Does mycophenolate mofetil decrease the recurrent acute rejection in renal transplant recipients.
abstract: OBJECTIVE
  Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transplant patients. However, it is expensive and cannot be used routinely in our population.
  
  
  METHODS
  In a retrospective study, 60 renal transplant patients on MMF based triple immunosuppression were analysed. The indication for MMF was as rescue therapy after treatment of acute vascular rejection (Banff type-4, grade IIA, IIB and III) in all patients. However, 20 such patients also had associated chronic liver diseases. The patients were given 1.5-2.0 g MMF in two divided doses at least for 6 months, depending upon the tolerability, adverse effects and affordability, and followed-up at least for 1 year. The control group consisted of 60 cases of acute vascular rejection (Banff type-4, grade IIA, IIB and III) who were placed on cyclosporine, azathioprine and steroid based maintenance immunosuppressive regimen in same time frame.
  
  
  RESULTS
  The incidence recurrent acute rejections in MMF group was 18% and 42% in control group (P < 0.005). The serum transaminases in all patients of the liver diseases became normal in 3-6 months. The incidence of opportunistic infections in MMF and control group were 22% and 11% respectively (P < 0.05). The MMF based regimen was two times more expensive. The 1 year patient and graft survivals between two groups were not statistically significantly different.
  
  
  CONCLUSIONS
  The MMF based regimen significantly decreases the recurrent acute rejections. However, it is expensive and cannot be used routinely in all patients in Indian scenario.
authors.affiliation: Department of Urology, Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. address-anees@sgpgi.ac.in
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Singh
authors.forename: Devendra
authors.initials: D
authors.lastname: Kumar
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
authors.forename: R K
authors.initials: RK
authors.lastname: Sharma
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003404:Creatinine / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use*; D007194:India; D016030:Kidney Transplantation / Q000191:economics; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid