CONVERSION FROM AZATHIOPRINA TO MYCOPHENOLATE MOFETIL IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS WITH CHRONIC REJECTION1

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Abstract
Background. Chronic rejection is the leading cause of graft failure.Both nonimmunological and immunological mechanisms contribute to this pathology. Methods. We studied changes in kidney function, mixed lymphocyte culture, cell-mediated lympholysis, serum HLA class Ι antigens, cytotoxic antibodies, and lymphocyte population before and after 6 months of follow-up in 22 pediatric renal transplanted patients. The immunosuppressive protocol used was: cyclosporine, azathioprine, and corticosteroids. Eight patients demonstrated chronic graft rejection (by biopsy), group Ι; and eight patients had no clinical evidence of chronic and/or acute rejection, group ΙΙ. Substitution of mycophenolate mofetil (MMF) (600 mg/m2 bid for azathioprine was done in patients of groups Ι and ΙΙ. Another six patients with chronic rejection, did not receive MMF, group ΙΙΙ. Results. Creatinine clearance increased in group Ι (44±5 vs. 51.1±6 ml/min/1.73 m2, P P P P P P P + decreased from 7.9±1.1 to 5.6±0.8%, P P + increased from 5.7±1.1 to 8.6±1.3 (P <0.05) only in group Ι. Conclusions. Our data suggest that substituting MMF for azathioprine therapy leads to an improvement in the immunosuppression and renal function in children with on-going chronic rejection.