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Chronic allograft nephropathy and mycophenolate mofetil introduction in paediatric renal recipients

Larissa Kerecuk1, Judy Taylor, Godfrey Clark

  • 1Department of Paediatric Nephrology, Guy's Hospital, St. Thomas' Street, London, SE1 9RT, UK. lkerecuk@doctors.org.uk

Pediatric Nephrology (Berlin, Germany)
|September 1, 2005
PubMed

Insights

Introducing mycophenolate mofetil (MMF) improved kidney function and reduced rejection in pediatric patients with chronic allograft nephropathy (CAN). This immunosuppressive therapy also lowered blood pressure, enabling calcineurin inhibitor-sparing protocols.

Area of Science:

  • Nephrology
  • Immunology
  • Pediatric Medicine

Background:

  • Chronic allograft nephropathy (CAN) is a significant complication in pediatric renal transplant recipients.
  • Calcineurin inhibitors (CNIs) are standard immunosuppressants but can have long-term toxicity.
  • Mycophenolate mofetil (MMF) has shown promise in adult CAN management.

Purpose of the Study:

  • To evaluate the efficacy of MMF introduction with CNI reduction in pediatric patients with CAN.
  • To assess the impact of MMF on graft function (GFR), rejection rates, and blood pressure.

Main Methods:

  • Retrospective analysis of 19 pediatric patients with CAN.
  • MMF was introduced, and calcineurin inhibitor doses were concurrently reduced.
  • Patients were followed for a mean of 13.2 months, with assessments of GFR, rejection, and blood pressure.

Main Results:

  • Glomerular filtration rate (GFR) improved significantly after MMF introduction (+26.2 ml/min/1.73 m2/year) compared to the period before (-32.7 ml/min/1.73 m2/year).
  • MMF significantly reduced graft rejection rates (P=0.01) and systolic blood pressure (P=0.01).
  • Hematological parameters remained stable, and antihypertensive treatment did not significantly change.

Conclusions:

  • MMF introduction is a beneficial strategy for pediatric renal transplant recipients with CAN.
  • MMF can lead to significant short-term and long-term improvements in GFR and may positively impact blood pressure.
  • MMF facilitates CNI-sparing protocols, potentially reducing long-term CNI-related toxicities.

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