Mycophenolate mofetil: clinical update

Since active clinical transplantation became a reality, physicians have been in constant conflict with the body's immunologic defenses. Steroids and azathioprine were the mainstay of immunosuppressive ther- apy for many years. During these years, graft survival was modest, with survival rates of 50%or less at one year for cadaver transplants. After the introduction of cyclospor ine A in 1983, renal cadaver graft survival rates increased to 60-75%. Since that time, other immunosuppressive agents such as OKT3and better patient management have increased 1-year graft survival rates well above 80%. Nevertheless, present immunosup- pressive regimens remain toxic, nonspecific, and render the patient at increased risk of infection and lym- phoproliferative disorders. Presently there exists no "magic bullet" that can render the immune system inca- pable of rejecting a graft while allowing the patient continued defense against infection. However, a new drug, mycophenolate mofetil (MMF; CellCept®;RS-6144-3)comes surprisingly close to this concept by ernpha- sizing a unique mechanism of action.