Mycophenolate Mofetil (MMF) is a potent immunosuppressive agent. It significantly reduces the rate of biopsy-proven acute rejection and the rate of progression to chronic allograft nephropathy. MMF related adverse events were reported in many of these trials. In recent studies dose reduction was correlated with increased rate of acute rejection and graft dysfunction. A cohort of 498 kidney recipients who received MMF as part of their immunosuppression was followed up in our center between January 1996 and December 2003. Clinical evaluation was done retrospectively through data retrieval from well-maintained transplant files. Incidence of first three months biopsy proven acute rejection was 22.8%. The type of induction immunosuppression did not affect it. MMF dose reduction during the first year did not increase the rate of acute rejection. Five years patient and graft survival was 96.3 and 94% respectively. Leucopenia was the most frequent haematological disorder (24.2%) while diarrhea was the main gastrointestinal side effect (16.1%). The incidence of cytomegalovirus infection was 16.6%. Urinary (29%) and respiratory (24.2%) tract infections were the most frequent bacterial infections. Proteinuria was seen in 55 recipients (12.6%) at five years post transplant. Mean time of onset was 15 months. Kidney biopsy in 17 out of 35 patients showed chronic allograft nephropathy. Eight patients reached end stage renal disease.
MMF is a potent immunosuppressive agent. Occasional dose reduction during the first year post transplant does not necessarily be associated with increased risk of rejection or graft dysfunction. Incidence of side effects may vary between different populations. The risk of graft loss due to CAN is much less with patients on MMF.