title: Mycophenolate mofetil maintenance therapy in renal transplant patients: long-term results of the TranCept STAY study.
abstract: BACKGROUND
  This prospective observational study documented long-term renal function in transplant recipients receiving mycophenolate mofetil (MMF).
  
  
  METHODS
  Kidney allograft recipients>6 months post-transplantation, with a glomerular filtration rate (GFR)>20 mL/min, receiving MMF from time of transplantation were enrolled and followed for four yr. Subgroups were identified based on time between transplantation and enrollment: Y<1 (6 months-1 yr); Y1-2 (>1-2 yr); Y2-5 (>2-5 yr) and Y>5 (>5 yr).
  
  
  RESULTS
  A total of 2040 patients were analyzed; 780, 410, 541 and 309 in subgroups Y<1, Y1-2, Y2-5 and Y>5. For all patients combined GFR decreased during the observational period by approximately 1 mL/min/yr (median GFR (mL/min) was 50.8, 50.5, 48.7, and 47.6 at one, two, three, and four yr). Survival estimates for decline in renal function (>20% GFR decline at one time point) were 78%, 66%, 57%, and 51% at one, two, three and four yr, with no significant differences between subgroups (p>0.05). In adult patients, higher doses of MMF (≥1 g/d) were associated with better GFR outcomes (median GFR (mL/min) 48.1 vs. 39.9 at four yr post-enrollment; p=0.0037). When comparing the effects of MMF combined with calcineurin inhibitors (CNIs), GFR was increased with lower doses of tacrolimus or cyclosporin. There were no major tolerability or acute rejection problems and graft survival was similar in all subgroups (graft survival estimates for all patients combined were 99%, 95%, 92%, and 90% at one, two, three, and four yr).
  
  
  CONCLUSIONS
  Long-term MMF immunosuppression preserves renal function and higher MMF doses combined with lower CNI doses may provide better patient outcomes.
authors.affiliation: Department of Nephrology, Clinic rechts der Isar, Technical University Munich, Munich, Germany. uwe.heemann@lrz.turn.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Amir
authors.initials: A
authors.lastname: Hamza
authors.forename: Jan Steffen
authors.initials: JS
authors.lastname: Jürgensen
authors.forename: Federico
authors.initials: F
authors.lastname: Juarez
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Arns
authors.forename: Thomas
authors.initials: T
authors.lastname: Rath
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid