Heart transplant recipient clinical profile improvement following mycophenolate mofetil late incorporation into the treatment schedule

Abstract: Mycophenolate mofetil (MMF) has a better clinical profile than azathioprine in heart transplantation (HT). Forty-five recipients (aged 53 ± 9 yr) were retrospectively evaluated (first year of follow-up) post-MMF introduction since its advent in 1997 (mean daily dose: 1.97 ± 0.2 g). MMF was used (mean post-HT time: 40 ± 27 months) for: (i) renal insufficiency attenuation (group 1 = 20); (ii) steroid reduction because of osteoporosis (group 2 = 12); (iii) treatment of persistent cellular rejection (group 3 = 7) and vascular graft disease (VGD) (group 4 = 6). Mean changes (groups 1–2) were: creatinine 172 ± 59, 158 ± 51, 153 ± 57 μmol/L (at baseline, 6 and 12 months, respectively; p < 0.001). Cyclosporine daily dose: 219 ± 37, 166 ± 46, 176 ± 98 mg, respectively (p < 0.001). Cyclosporine blood concentration: 151 ± 40, 103 ± 41, 83 ± 34 ng/mL, respectively (p < 0.004). Prednisone daily dose: 8.3 ± 2, 5.2 ± 1, 4.1 ± 1 mg, respectively (p < 0.001). Cellular rejection (group 3) was successfully treated (86%) but the outcome of VGD did not improve after the switch (group 4). Our limited experience (with caution) confirms the reported benefits of MMF particularly attenuating renal insufficiency.