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Mycophenolate mofetil (MMF) is a new immunosuppressant developed for the prevention and treatment of acute renal rejection after transplantation. Diarrhea is the most frequent side effect observed during treatment with MMF. Its pathogenic mechanisms remain unknown. We describe a case of severe diarrhea due to villous atrophy in a renal transplant recipient during treatment with MMF. The patient was free of symptoms before MMF. Villous atrophy disappeared a few months after MMF withdrawal.

In a selected transplant population with biopsy-proven CsA nephrotoxicity, CsA withdrawal with a concomitant switch from AZA to MMF seems to be safe and allows a significant improvement of renal function.

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Because recent large studies have demonstrated that mycophenolate mofetil (MMF) is superior to azathioprine (AZA) as a posttransplant immunosuppressant, it has been speculated that MMF could have a cyclosporin (CsA)-sparing effect in renal transplant recipients with chronic allograft dysfunction. Between April 1996 and October 1998, 31 patients with chronic allograft dysfunction were assigned to have conversion from AZA to MMF with concomitant CsA withdrawal. Patient and graft outcomes were analysed. Mean follow-up time after MMF conversion was 27 * 11 months. Serum creatinine concentration (sCt) significantly decreased after conversion and remained stable at the end of followup (227 * 3 1 pmol/l vs. 185 It 50 pmol/l; P < 0.0005). Mean variation in sCt was -24% after conversion, whereas it was +20% in the year before conversion ( P < 0.001). There was a significant inverse relationship between proteinuria at baseline and improvement in renal function (r = -0.35; P = 0.01). Proteinuria increased during follow-up (0.79 It 0.6 vs.

Renal transplant recipients have a well-recognized increased risk of de novo neoplasia. In this study, we investigated whether lymphocyte subset count could predict the risk of developing noncutaneous neoplasia (NCSC) in renal transplant recipients (RTR). Between January 1995 and December 1995, lymphocyte subsets (CD4, CD8, CD19) were measured in 28 1 RTR. This population was studied until November 1999 for the development of NCSC. The mean follow-up was 42 k 9 months. Neoplasm was diagnosed in 22 patients (7.9%). Patients who developed a cancer were significantly older (53.8 * 6 years vs 38 & 16 years, P < O.OOOl), had lower CDq (234 f 126/mm3 vs 543 i214/pm3, P < 0.005) and CD19 (19 k 9/mm3 vs 51 * 22/mm3, P < 0.0001) levels, and more frequently had past histories of skin cancer (24% vs 4%, P < 0.01). Cox regression revealed that high CD4 levels (RR 0.73, 95% CI 0.62-0.89 for each 100/mm3 increase in CD4 cell count) were associated with decreased risk of NCSC, whereas age (RR 2.49, 95% CI 1.12-5.92 for each l0-year increase in age) was predictive of the subsequent development of NCSC. To conclude, CD4 cell depletion is associated with the development of solid cancers and lymphoma in RTR.

SummaryWe conducted the first prospective, randomized, open-label multicenter study in low-immunologic risk adult recipients of primary cadaver kidney transplants receiving rabbit anti-T-lymphocyte globulin, mycophenolate mofetil, cyclosporine microemulsion introduced on day 5, with and without corticosteroids. Patients were randomly assigned according to age and cold ischemia time to receive corticosteroids for at least 6 months or no corticosteroids at all. The main efficacy evaluation criterion was acute rejection (including all treated episodes and those biopsy-confirmed) during the first year following transplantation. For this purpose, this report includes the actual results of the whole 12-month follow-up of all randomized patients. For efficacy analysis, 98 patients were evaluated in the Steroid avoidance group and 99 in the Steroid maintenance group. Taken as a whole, 81% of the patients (n = 159) never received anti-rejection treatment. From the 38 patients who received antirejection treatment, 25 (25.5%) were in the Steroid avoidance group and 13 (13.1%) in the Steroid maintenance group (P < 0.031), experiencing respectively 17 (17.3%) and 7 (7.1%) biopsy-proven first episodes of acute rejection (P < 0.031). Borderline changes (6 vs. 3) were not considered as biopsy-proven acute rejections. Onset of first rejection was significantly shorter in the Steroid avoidance group (P < 0.027). First-line anti-rejection treatment response, need for any rescue therapy, as well as histologic severity of rejection episodes did not statistically differ between the groups. One-year post-transplantation analysis showed no differences in delayed graft function, serum creatinine, creatinine clearance, 24-h proteinuria, as well as serious adverse events between the groups. De novo diabetes (P < 0.07) or dyslipidemia (P < 0.01) as well as newly diagnosed malignancies (P < 0.059) were however more frequently observed in the Steroid maintenance group. At the end of the first post-transplant year, 99% of patients in the Steroid avoidance group and 97% of patients in the Steroid maintenance group were respectively alive (P = 0.34), with respectively 95% and 93.2% of functioning kidney grafts (P = 0.62). Our results showed Transplant International

One hundred ninety-seven patients received anti-Tlymphocyte globulins Fresenius, mycophenolate mofetil and delayed cyclosporine, and were randomized to !6-month corticosteroids (þCS; n ¼ 99) or no CS (ÀCS; n ¼ 98). One-and five-year actual graft survival (censored for death) was 93.2% and 86.4% in the þCS group versus 94.9% and 89.8% in the ÀCS group (5-year follow-up, p ¼ 0.487). Freedom from clinical rejection was 86.9% and 81.8% versus 74.5% and 74.5% (p ¼ 0.144), respectively, at 1 and 5 years; 5-year freedom from biopsyproven rejection was 88.9% versus 83.7% (p ¼ 0.227). More late first rejections occurred in the þCS group. Significantly lower 5-year graft survival in patients experiencing rejection was observed for þCS (55.6% vs. 92.0%; p ¼ 0.005) with 8/18 versus 2/25 graft losses. Renal function at 5 years was stable and comparable (median serum creatinine, 159 vs. 145 mmol/L; creatinine clearance, 53.5 vs. 56.6 mL/min). More þCS patients developed diabetes, dyslipidemia and malignancies. Rejections in ÀCS patients occurred early after transplantation and did not impair long-term renal function. In patients receiving CS, rejections occurred later and with a higher risk for subsequent graft failure. A similar and not inferior 5-year efficacy profile and a reduced morbidity were observed in CS-free patients compared to patients who received CS for at least 6 months.