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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2003 March;55(1):91-9

language: English

Mycophenolate mofetil in pediatric renal transplantation

Weber L. T., Höcker B., Mehls O., Tönshoff B.

Division of Pediatric Nephrology, University Children’s Hospital, Heidelberg, Germany

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Since my­co­phen­o­late mofe­til (MMF), an es­ter pro­drug of the im­mu­no­sup­press­ant my­coph­e­nol­ic ac­id (MPA), has ­been ap­proved for main­te­nance im­mu­no­sup­pres­sive ther­a­py al­so in chil­dren af­ter re­nal trans­plan­ta­tion it has be­come an im­por­tant ­part of im­mu­no­sup­pres­sive pro­to­cols. By in­hib­it­ing in­osine mono­phos­phate de­hy­drog­e­nase, the key en­zyme in the de no­vo pu­rine bi­o­syn­the­sis of pro­life­rat­ing T and B lym­pho­cytes, MMF ­acts as a rel­a­tive­ly spe­cif­ic in­hib­i­tor of hu­man lym­pho­cyte pro­life­ra­tion. MMF is ­more ef­fec­tive ­than az­a­thi­o­prine in com­bi­na­tion ­with cy­clo­spor­in A (CsA) and cor­ti­cos­ter­oids and dis­tinct­ly re­duc­es the in­ci­dence of ­acute re­jec­tion epi­sodes in the ­1st ­year ­post-trans­plant in ­adults as ­well as in chil­dren. Beneficial ef­fects on ster­oid-re­sist­ant re­jec­tion and chron­ic al­lo­graft dys­func­tion ­have ­been ­shown. In gen­er­al, MMF is ­well tol­er­at­ed. Major ad­verse ­events in pe­di­at­ric re­nal trans­plant re­cip­ients in­clude leu­ko­pe­nia, in­fec­tions and gas­troin­tes­ti­nal prob­lems. Pharmacokinetic mon­i­tor­ing of MPA can ­help to op­tim­ise MMF ther­a­py af­ter re­nal trans­plan­ta­tion, as as­so­ci­a­tions ­between the ­risk of ­acute re­jec­tion epi­sodes and MPA-AUC val­ues and MPA pre­dose lev­els ­have ­been dem­on­strat­ed. The in­ci­dence of MMF-re­lat­ed ­side ef­fects ­such as leu­ko­pe­nia and/or in­fec­tions, how­ev­er, is as­so­ciat­ed ­with phar­ma­cok­i­net­ic pa­ram­e­ters of ­free MPA. Reference ­data of rel­e­vant phar­ma­cok­i­net­ic pa­ram­e­ters are avail­able. The pos­sible ster­oid-spar­ing po­ten­tial of MMF is an im­por­tant is­sue in pe­di­at­ric re­nal trans­plan­ta­tion. Preliminary ­data dem­on­strate im­proved lon­gi­tu­di­nal ­growth, ­less cu­shin­goid hab­it­us and low­er ­blood pres­sure af­ter ster­oid-with­draw­al in pe­di­at­ric re­nal trans­plant re­cip­ients ­under MMF and CsA ther­a­py.

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