Mycophenolate Mofetil이 이식신의 급성 거부반응에 미치는 영향

Abstract

Mycophenolate mofetil (MMF) is a novel new immunosuppressant which suppress proliferation of T and B lymphocytes by inhibiting inosine monophosphate dehydrogenase. Even though the results we can get now are still preliminary but the positive result such as low incidence of acute rejection episode, is very attractive to clinical therapist. It also has certain effect on rescue therapy of steroid resistant acute rejection. There is little proven report of long-term follow up of this drug but the improvement of early graft survival suggest better long-term result. From March 1997, we used MMF as one of the primary immunosuppressant with cyclosporine and steroid in 47 renal allograft recipient (MMF group) and the early result of this protocol is compared with control group using conventional two drug regimen (cyclosporine and steroid)in 96 recipients. The 2 g of MMF were given daily from 2nd post-transplant day. The acute rejection episode within 3 and 6 months are 12.1 and 12.8% in MMF group and these are statistically significant difference with the results of control group (36.5% and 38.5% respectively, P＜0.005). The response rate of acute rejection to steroid pulse therapy was 66.7% in MMF group but has no statistical difference with that of conventional group (84.1%). Steroid resistant severe acute rejection that needed to use OKT3 was developed in 1 case (2.1%) in MMF group but 7 (7.3%) in control group. Among the complication, post-transplant infection occurred in 6 cases (12.8%) of MMF group but in 8 cases (8.3%) in control group. Diarrhea that needed medication developed in 8 cases of MMF group (17.0%), but only one of them is necessary to change his immunosuppressive regimen. Leukopenia also developed in 1 case of each group. In summary, the incidence of acute rejection episode and steroid resistant rejection that is necessary to use OKT3 is significantly decreased in MMF group but the response rate to steroid pulse therapy and complications of both groups showed no statistical difference.