Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
Effect of mycophenolate mofetil in heart transplantation.
Can J Surg. 2000 Jun;43(3):202-6. Unique Identifier : AIDSLINE MED/20309963 Mathieu P; Carrier M; White M; Pellerin M; Perrault L; Pelletier G; Robitaille D; Pelletier LC; Department of Surgery, Montreal Heart Institute, Que.
Abstract:
OBJECTIVE: To study the effect of mycophenolate mofetil (MMF), a new immunosuppressive drug that acts by inhibiting de novo pathways of purine synthesis, and rabbit antithymocyte globulin (RATG) on the lymphocyte subpopulation after heart transplantation. DESIGN: A review of clinical and laboratory records. SETTING: The Montreal Heart Institute. PATIENTS: Thirty-one patients who underwent heart transplantation. In 9 patients, neoral cyclosporine, prednisone and azathioprine were administered (group 1). In 14 patients RATG was added during the first 3 postoperative days (group 2) and in 8 patients RATG and combination immunosuppression was given, but MMF was used instead of azathioprine (group 3). The demographic characteristics of donors and recipients were similar among the 3 groups. MAIN OUTCOME MEASURES: The proportion of CD2, CD4 and CD8 receptor-positive lymphocytes, expressed as a mean (and standard deviation) percentage of the total lymphocyte population, measured at 7, 15 and 30 days and 6 months after transplantation. RESULTS: At 7 days after transplantation, CD2 lymphocytes averaged 55% (18%), 16% (15%) and 14% (11%) in groups 1, 2 and 3 respectively (p < 0.05), CD4 averaged 36% (11%), 9% (12%) and 7% (8%) in groups 1, 2 and 3 (p < 0.05), and CD8 averaged 14% (6%), 4% (3%) and 4% (3%) in groups 1, 2 and 3 (p < 0.05). At 15 days after transplantation CD2 averaged 69% (10%), 42% (16%) and 47% (20%) in groups 1, 2 and 3 respectively (p < 0.05), and CD8 averaged 16% (7%), 16% (6%) and 19% (7%) (p = NS). At 30 days after transplantation the percentages of CD2, CD4 and CD8 lymphocytes were similar among the groups. The freedom rate from acute rejection averaged 22% (14%), 9% (8%) and 50% (18%) (p < 0.05) in groups 1, 2 and 3 at 6 months after transplantation, and the freedom rate from infection averaged 56% (17%), 36% (13%) and 38% (17%) for the 3 groups at this time period (p = NS). CONCLUSIONS: A short course of RATG causes severe, transitory depletion of CD2, CD4 and CD8 lymphocyte subpopulations. MMF decreases the incidence of early acute rejection after heart transplantation without affecting the lymphocyte subpopulation when compared with azathioprine.
Keywords: JOURNAL ARTICLE Animal Anti-Inflammatory Agents, Steroidal/THERAPEUTIC USE Antigens, CD2/*DRUG EFFECTS Antigens, CD8/*DRUG EFFECTS Antilymphocyte Serum/*THERAPEUTIC USE Azathioprine/THERAPEUTIC USE Comparative Study Cyclosporine/THERAPEUTIC USE CD4 Lymphocyte Count/*DRUG EFFECTS Drug Therapy, Combination Graft Rejection/PREVENTION & CONTROL Heart Transplantation/ADVERSE EFFECTS/*IMMUNOLOGY/MORTALITY Human Immunosuppressive Agents/PHARMACOLOGY/*THERAPEUTIC USE IMP Dehydrogenase/*ANTAGONISTS & INHIB Lymphocyte Count/*DRUG EFFECTS Lymphocyte Subsets/*DRUG EFFECTS Mycophenolic Acid/*ANALOGS & DERIVATIVES/PHARMACOLOGY/THERAPEUTIC USE Prednisone/THERAPEUTIC USE Rabbits Retrospective Studies Survival Analysis Treatment Outcome
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Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
