Mycophenolate mofetil, an alternative to cyclosporine A for long-term immunosuppression in kidney transplantation?

Background. Mycophenolate-mofetil (MMF) is a non-nephrotoxic immunosuppressant most often used in combination with cyclosporine A (CsA) and prednisone (Pred). This study reports the outcome of 17 adult renal recipients whose immunosuppressive regimen was changed from CsA-Pred to MMF-Pred because of CsA nephrotoxicity. Methods. CsA nephrotoxicity was diagnosed in all patients based on suggestive histopathological lesions on a renal biopsy. Sixteen patients had deteriorating graft function and 1 had isolated persistent proteinuria. Immunosuppressive therapy was changed 57 +/- 32 months posttransplant. Results. After replacement of CsA by MMF, a reduction in serum creatinine was observed in all patients (mean 26 +/- 17%). This reduction was maintained 20 +/- 8 months after the change in therapy without any episodes of acute rejection. Serum lipids and blood pressure also decreased significantly. Conclusion. This study demonstrates that MMF-Pred can be an effective long-term immunosuppressive treatment alternative for renal transplant patients experiencing CsA nephrotoxicity. Such treatment may result in improved graft function, and better control of hypertension and hyperlipidemia.