BENEFICIAL EFFECT OF LOW DOSE CYCLOSPORINE WITH MMF (MY COPHENOLATE MOFETIL) IN RENAL ALLOGRAFT RECIPIENTS

Background: Calcineurin inhibitors (CNI) have significantly reduced the incidence of acute rejection. Nephrotoxicity however may contribute to long-term allograft dysfunction. Mycophenolate mofetil (MMF) may allow cyclosporine (CsA) dose reduction without increasing the risk of rejection. Methods: In seventy-eight living unrelated kidney transplant patients with renal dysfunction, we studied the effect of Cs A dose reduction in association with MMF on renal function and cardiovascular risk profile. Results: We reduced the cyclosporine dose from mean 3.5±0.94 mg/kg/d to 2±0.51 mg/kg/d, p<0.0001. Mean follow up duration was 22.99±8.98 weeks. The reduction of CsA was associated with decrement of median serum creatinine from 1.7±0.99 mg/dL to 1.3±0.52 mg/dL, p<0.0001. We found improvement in lipid profile, mean cholesterol level from 212.73±41.72 to 199.69±37.33 mg/dL, p<0.002 and also with triglyceride from 195.28±92.21 to 167.64±60.82 mg/dL,p<0.005. No rejection episodes occurred, and an improvement in systolic and diastolic pressure was observed from 131.4±21.26 to 127.83±17.53 mm/Hg, p<0.01 and from 82.82±13.15 to 78.88±83 mmHg, p<0.03 respectively. No significant difference in plasma uric acid level was observed after CsA reduction, p<0.06. Conclusion: This study suggests that CsA reduction is safe and is not associated with an increased risk of acute rejection. It also has the potential to improve allograft function and appears to reduce cardiovascular risk factors such as hypertension and hyperlipidemia.