Mycophenolate mofetil in renal allograft chronic dysfunction

We studied 32 renal transplant recipients with allograft survival longer th an 6 months with chronic renal allograft failure. The aim of this study was to analyze the influence of mycophenolate mofeil in these patients chronic renal dysfunction. Twenty-four patients were examined by percutaneous renal biopsy before the introduction of MMF. The hystologic diagnosis was: chronic rejection in 14 patients, cyclosporin A nephrotoxicity in 7 patients and both of these in 3 patients. Serum creatinine was measured montly from 12 months pre-treatmen t. Mean follow-up time was 11.6 +/- 6.6 moths. Progressive increase was observed in serum creatinine from 12 months pre-tr eatment to time zeto (t0) (p < 0,05). The average creatinine at the initiat ion of the treatment was 2.7 mg/dl. After the introduction of MMF we observ ed a progressive decline in renal function with a rise in mean serum creati nine, however, it was not statistically significant. In a least-squares lin ear regression model, the slope of the reciprocal of creatinine versus time was: before the change in inmunosuprresion: b = -0.38 x 10(-3), r = 0.91 ( p = 0.01) and after MMF: b = -0.04 x 10(-3), r = 0.35 (p = 0.2). We divided the patients into two groups in relation to the histologic findi ngs: group A (chronic rejection) and group B (CsA nephrotoxicity). In the g roup A significant increase in serum creatinine was observed up +12 months (p < 0.05), while in group B a significant decrease in serum creatinine was observed at +2, +3, +4 and +15 months (p < 0.05). The average dose of CsA was reduced by 27%; this reduction was highest in group B. 5 patients the s tudy on return to dialysis. At the time of starting MMF, serum creatinine w as < 3 mg/dl in 4 of these patients. Conclusion: Our initial results suggest than MMF may decrease the severity of the evolution of chronic renal allograft nephropathy That evolution was better in group B, valued could be due to the decreased, dose of CsA.