Mycophenolate Mofetil and C-Reactive Protein in Renal Transplant Recipients

Abstract

C-reactive protein (CRP) is a strong predictor of cardiovascular disease, all-cause mortality, and renal allograft loss. Little is known about the effects of immunosuppressive and cardiovascular risk-modifying drugs on CRP in renal transplant recipients. We retrospectively identified stable patients with > or =1 highly sensitive CRP measurements between January 1 and August 31, 2005. Variables collected included patient demographics; transplant, dialysis, and cardiovascular disease-related variables; and medication profiles. Univariate correlations with CRP were assessed by unpaired Student t testing, analysis of variance, or chi analysis and followed by multivariate linear regression with stepwise backward elimination until a final stable model was attained. CRP levels were obtained in 298 recipients. In univariate analysis, body mass index (P<0.0001) and systolic blood pressure (P=0.009) showed a positive correlation, whereas number of immunosuppressive drugs (P=0.05) and use of mycophenolate mofetil (MMF) (P=0.003) were negatively correlated with CRP levels. By multivariate analysis, only body mass index (P<0.0001) and MMF dose (P<0.0001) were independently and opposingly correlated with CRP. Mean CRP level was 5.18+/-5.7 mg/L in patients not taking MMF compared with 3.13+/-3.5 mg/L in those on 2000 mg per day (P=0.002). MMF use correlates inversely with CRP levels in renal transplant recipients, suggesting that immunosuppressive regime design may alter allograft and cardiovascular disease risk in these patients. Prospective study of the effects of MMF on novel cardiovascular disease risk factors such as CRP is warranted.