title: Effect of mycophenolate mofetil on progression of interstitial fibrosis and tubular atrophy after kidney transplantation: a retrospective study.
abstract: OBJECTIVE
  Chronic transplant dysfunction after kidney transplantation is a major reason of kidney graft loss and is caused by immunological and non-immunological factors. There is evidence that mycophenolate mofetil (MMF) may exert a positive effect on renal damage in addition to immunosuppression, by its direct antifibrotic properties. The aim of our study was to retrospectively investigate the role of MMF doses on progression of chronic allograft dysfunction and fibrosis and tubular atrophy (IF/TA).
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  Patients with kidney transplant in a tertiary care institution. This is a retrospective cohort study that included 79 patients with kidney and kidney-pancreas transplantation. Immunosuppression consisted of anti-interleukin 2 antibody induction, MMF, a calcineurin inhibitor±steroids.
  
  
  METHODS
  An association of average MMF doses over 1 year post-transplant with progression of interstitial fibrosis (Δci), tubular atrophy (Δct) and estimated-creatinine clearance (eCrcl) at 1 year post-transplant was evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  A higher average MMF dose was significantly independently associated with better eCrcl at 1 year post-transplant (b=0.21±0.1, p=0.04). In multiple regression analysis lower Δci (b=-0.2±0.09, p=0.05) and Δct (b=-0.29±0.1, p=0.02) were independently associated with a greater average MMF dose. There was no correlation between average MMF doses and incidence of acute rejection (p=0.68).
  
  
  CONCLUSIONS
  A higher average MMF dose over 1 year is associated with better renal function and slower progression of IF/TA, at least partly independent of its immunosuppressive effects.
authors.affiliation: Renal Division, Department of Medicine, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Karlo
authors.initials: K
authors.lastname: Mihovilović
authors.affiliation: Renal Division, Department of Medicine, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Bojana
authors.initials: B
authors.lastname: Maksimović
authors.affiliation: Department of Surgery, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Branislav
authors.initials: B
authors.lastname: Kocman
authors.affiliation: Department of Anaesthesiology, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Denis
authors.initials: D
authors.lastname: Guštin
authors.affiliation: Department of Urology, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Vidas
authors.affiliation: Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia.
authors.forename: Stela
authors.initials: S
authors.lastname: Bulimbašić
authors.affiliation: Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Danica Galešić
authors.initials: DG
authors.lastname: Ljubanović
authors.affiliation: Renal Division, Department of Medicine, Clinical Hospital Merkur, Zagreb, Croatia.
authors.forename: Mirjana Sabljar
authors.initials: MS
authors.lastname: Matovinović
authors.affiliation: Renal Division, Department of Medicine, Clinical Hospital Merkur, Zagreb, Croatia University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Mladen
authors.initials: M
authors.lastname: Knotek
mesh_terms: D000328:Adult; D001284:Atrophy / Q000517:prevention & control; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: Transplant Medicine