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Effect of MMF Immunosuppression Based on CNI Reduction on CNI-Related Renal Damage after Lung Transplantation
Chunxai Tang1, Wei Wang1, Yuxi Xue1
1Special Needs Section, Jiangsu Wuxi People's Hospital, Wuxi 214000, China.
Abstract:
In this paper, numerous effects of immunosuppressive regimen of mycophenolate mofetil (MMF) on CNI-related renal damage after lung transplantation are evaluated thoroughly. For this purpose, 110 lung transplant recipients who were treated in our hospital from March 2016 to January 2018 were randomly selected. All patients took prednisone acetate tablets or rapamycin at the same time or not at the same time. MMF is 1 g every time, twice a day, and adjusted according to the re-examination. According to the different drugs taken by 110 patients, they were divided into cyclosporine A group and tacrolimus group. Among them, 92 patients in cyclosporine A group took cyclosporine A; 18 patients in tacrolimus group took tacrolimus. The clinical data of age and gender of the two groups were collected, To observe and compare the occurrence of CNI-related renal damage in lung transplant recipients and different immunosuppressants. The CNI dosage of tacrolimus group and cyclosporine A group was compared before and after MMF. The changes of serum creatinine level and serum creatinine clearance rate were measured before MMF administration and 30, 60, and 90 days after MMF administration, to observe the complications of CNI-related renal damage after lung transplantation. Experimental results showed that there were 16 cases (14.55%) of CNI-related renal damage in lung transplant recipients and different immunosuppressants, including 10 cases (11.36%) in males, 6 cases (27.27%) in females, 11 cases (12.09%) in tacrolimus group, and 5 cases (26.32%) in cyclosporine A group. There was no significant difference between the two groups (P > 0.05). Compared with MMF before and after administration, CNI dosage of cyclosporine A group and tacrolimus group decreased significantly (P < 0.01). Compared with MMF before administration, serum creatinine level decreased and serum creatinine clearance rate increased significantly (P < 0.05). In the follow-up, 16 patients with CNI-related renal damage were found to be immune rejection before the adjustment of immunosuppression program, no complications such as immune rejection, myelosuppression, and infection occurred within 15 months after the adjustment of immunosuppression program, blood glucose increased in 3 patients within 2 years after operation, blood lipid increased in 1 patient, urea increased in 1 patient, and uric acid increased in 1 patient. MMF immunosuppressive therapy based on CNI reduction is a safe and effective immunosuppressive therapy, which can significantly reduce immune rejection, improve renal function, and play an important role in improving CNI-related renal damage after lung transplantation.
Insights
Mycophenolate mofetil (MMF) effectively reduces calcineurin inhibitor (CNI) dosage in lung transplant recipients, significantly improving renal function. This immunosuppressive therapy is safe and crucial for mitigating CNI-related renal damage.
Area of Science:
- Nephrology
- Immunology
- Thoracic Surgery
Background:
- Calcineurin inhibitors (CNIs) are vital for preventing organ rejection but can cause significant renal damage.
- Lung transplant recipients often require long-term immunosuppression, increasing the risk of CNI-related nephrotoxicity.
- Evaluating alternative or adjunctive immunosuppressive regimens is crucial for improving long-term outcomes.
Purpose of the Study:
- To assess the impact of mycophenolate mofetil (MMF) on calcineurin inhibitor (CNI)-related renal damage in lung transplant recipients.
- To compare the efficacy of MMF in patients treated with cyclosporine A versus tacrolimus.
- To evaluate changes in renal function markers following MMF administration.
Main Methods:
- A cohort of 110 lung transplant recipients was analyzed.
- Patients received either cyclosporine A or tacrolimus, with MMF added to their regimen.
- Serum creatinine levels and creatinine clearance rates were measured before and at 30, 60, and 90 days after MMF administration.
- CNI dosages were compared pre- and post-MMF initiation.
Main Results:
- MMF administration led to a significant reduction in CNI dosage in both cyclosporine A and tacrolimus groups (P < 0.01).
- Serum creatinine levels decreased, and creatinine clearance rates increased significantly after MMF initiation (P < 0.05).
- 14.55% of patients experienced CNI-related renal damage, with no significant difference between the two CNI groups.
Conclusions:
- MMF-based immunosuppressive therapy, coupled with CNI reduction, is a safe and effective strategy for lung transplant recipients.
- This approach significantly improves renal function and reduces the incidence of CNI-related renal damage.
- MMF plays a vital role in managing immunosuppression and mitigating nephrotoxicity post-lung transplantation.
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