Mycophenolat Mofetil und niedrigdosiertes Cyclosporin A verbessern die eingeschränkte Nierenfunktion von Herzempfängern

Abstract

Cyclosporin A (CSA) nephrotoxicity is a common problem after cardiac transplantation. We have studied the impact of CSA dose reduction in association with mycophenolate mofetil (MMF) treatment on renal function in heart transplant recipients with suspected CSA nephrotoxicity (serum creatinine >2mg/dl). Methods: 14 heart transplant recipients (12 men, 2 women; 111 to 1813 d post transplant) with CSA-based immunosuppression (plus azathioprine and/or steroids) and a serum creatinine >2mg/dl were started on a daily dose of MMF of 2000mg. Dilated cardiomyopathy was the underlying disease in 10 pts, ischemic cardiomyopathy in 4. Mean patient age was 57 yrs (range 44–69 yrs). Azathioprine was discontinued and CSA slowly tapered. Creatinine clearance, serum creatinine, urea nitrogen, and uric acid were monitored. Cyclosporine levels were measured and CSA dose adjusted for whole blood levels of 70–120μg/l. 12 pts still had endomyocardial biopsies while 2 had echocardiographic controls only.¶Results: Two rejection episodes grade 1B acc. to ISHLT were observed until one year after switch to MMF. Results: Two rejection episodes grade 1B acc. to ISHLT were observed until one year after switch to MMF. ¶ Parameter Baseline¶(N=14) Late Follow-Up (N=14) P¶ Serum creatinine (mg/dl) 2.5 ± 0.8 1.8 ± 0.6 0.001 Blood urea nitrogen (mg/dl) 51 ± 18 41 ± 17 0.008 Uric acid (mg/dl) 9.9 ± 2.1 8.1 ± 2.3 0.005 Creatinine clearance (ml/min) 45 ± 20 60 ± 36 0.01 Whole blood CSA level (μg/l) 177 ± 54 106 ± 28 <0.001 Conclusions: Conversion from azathioprine to MMF with consecutive reduction of CSA in heart transplant recipients with CSA-induced renal impiarment improves renal function as evidenced by lower serum creatinine, urea nitrogen, uric acid, and higher creatinine clearance.