Mycophenolate mofetil in kidney transplantation

Abstract

Mycophenolate mofetil is a new immunosuppressive agent recently released for clinical use, in conjunction with steroids and cyclosporine, for the prevention of acute rejection in renal transplant patients. It inhibits the enzyme inosine monophosphate dehydrogenase, which is essential for de-novo synthesis of guanine nucleotides. The result is lymphocyte-selective arrest of cell division, with little effect on other tissues. In clinical trials in renal transplant, its efficacy and safety have been established: mycophenolate mofetil reduces acute rejection episodes by approximately 50%, with the principal toxicity being gastrointestinal, and perhaps some increase in cytomegalovirus infection. Overall, mycophenolate mofetil (plus cyclosporine and steroids) has a toxicity profile similar to that of azathioprine but with considerably increased efficacy. Despite its cost, mycophenolate mofetil is likely to be used in many renal transplant centres to reduce acute rejection, especially in the first year. Future trials are necessary to establish its long-term role in renal transplantation and its usefulness in the transplantation of other organs.