IMPROVED OUTCOME AND STEROID WITHDRAWAL IN MYCOPHENOLATE MOFETIL TREATED PRIMARY CADAVERIC RENAL TRANSPLANT RECIPIENTS

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232 The long term of corticosteroids in renal transplant recipients continues to be associated with significant morbidity even in the Cyclosporine (CSA) era. Although steroid withdrawal (STW) utilizing maintenance therapy with CSA/azathioprine (AZA) results in a reduction in steroid complications, an increased risk of acute rejection in the early withdrawal period and a gradual but significant increase in the serum creatinine during long term followup was noted. The substitution of Mycophenolate Mofetil (MMF) for AZA has lead to an overall reduction in the number and severity of acute rejection episodes. We report the short term outcome of STW in 2 groups: 18 CSA/MMF treated primary cadaveric renal transplant recipients and 95 CSA/AZA treated patients. STW was initiated in both groups as 9 months posttransplant when the maintenance methylprednisolone dose was 10 mg/day. A decrease of 2 mg/month was started until complete STW. Inclusion criteria for STW required a serum creatinine < 2.5 mg/dl and no prior steroid resistant rejections requiring antibody therapy. MMF was dosed at 1 g twice daily and AZA was provided at 1.5 mg/kg/day. Mean followup was 13 ± 8 months in the CSA/MMF group and 64 ± 32 months in the CSA/AZA group (p < 0.05). STW was accomplished at the same time posttransplant in both groups (CSA/MMF - 14± 2 months vs. 14 ± 3 months for CSA/AZA, p=ns). The incidence of prior steroid sensitive rejection episodes was lower in the CSA/MMF group - 12% vs. CSA/AZA group - 25% (p < 0.05). The 1 and 2 year success of maintaining complete STW was significantly higher and the incidence of acute rejection after STW and recurrent glomerulonephritis (RCR GN) was lower in the CSA/MMF group. TableThe serum creatinine was slightly but not significantly lower in the CSA/MMF group at 1 year (1.5 ± 0.2 mg/dl vs. 1.7 ± 0.2 mg/dl-CSA/AZA) and 2 years (1.5 ± 0.2 mg/dl vs. 1.8 ± 0.3 mg/dl- CSA/AZA). In conclusion, the combined use of CSA/MMF after STW resulted in improved 1 and 2 year success rates with a reduction in the risk of acute rejection after STW compared to a CSA/AZA based protocol. A reduction in early posttransplant rejection episodes may play a role in this improved outcome. MMF appears to add more potent short and long term immunosuppression which may increase the opportunity to achieve successful STW.

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