Effect of mycophenolate mofetil in heart transplantation

To study the effect of mycophenolate mofetil (MMF), a new immunosuppressive drug that acts by inhibiting de novo pathways of purine synthesis, and rabbit antithymocyte globulin (RATG) on the lymphocyte subpopulation after heart transplantation. A review of clinical and laboratory records. The Montre...

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Bibliographic Details
Published in:Canadian Journal of Surgery 2000-06, Vol.43 (3), p.202-206
Main Authors: Mathieu, P, Carrier, M, White, M, Pellerin, M, Perrault, L, Pelletier, G, Robitaille, D, Pelletier, L C
Format: Article
Language:English
Subjects:
AIDS/HIV
Animals
Anti-Inflammatory Agents - therapeutic use
Antilymphocyte Serum - therapeutic use
Azathioprine - therapeutic use
CD2 Antigens - drug effects
CD4 Lymphocyte Count - drug effects
CD8 Antigens - drug effects
Cyclosporine - therapeutic use
Drug Therapy, Combination
Drugs
Graft Rejection - prevention & control
Heart
Heart Transplantation - adverse effects
Heart Transplantation - immunology
Heart Transplantation - mortality
Humans
Immunosuppressive Agents - pharmacology
Immunosuppressive Agents - therapeutic use
IMP Dehydrogenase - antagonists & inhibitors
Lymphocyte Count - drug effects
Lymphocyte Subsets - drug effects
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - pharmacology
Mycophenolic Acid - therapeutic use
Original
Prednisone - therapeutic use
Rabbits
Retrospective Studies
Survival Analysis
Testing
Transplants & implants
Treatment Outcome
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Summary:To study the effect of mycophenolate mofetil (MMF), a new immunosuppressive drug that acts by inhibiting de novo pathways of purine synthesis, and rabbit antithymocyte globulin (RATG) on the lymphocyte subpopulation after heart transplantation. A review of clinical and laboratory records. The Montreal Heart Institute. Thirty-one patients who underwent heart transplantation. In 9 patients, neoral cyclosporine, prednisone and azathioprine were administered (group 1). In 14 patients RATG was added during the first 3 postoperative days (group 2) and in 8 patients RATG and combination immunosuppression was given, but MMF was used instead of azathioprine (group 3). The demographic characteristics of donors and recipients were similar among the 3 groups. The proportion of CD2, CD4 and CD8 receptor-positive lymphocytes, expressed as a mean (and standard deviation) percentage of the total lymphocyte population, measured at 7, 15 and 30 days and 6 months after transplantation. At 7 days after transplantation, CD2 lymphocytes averaged 55% (18%), 16% (15%) and 14% (11%) in groups 1, 2 and 3 respectively (p < 0.05), CD4 averaged 36% (11%), 9% (12%) and 7% (8%) in groups 1, 2 and 3 (p < 0.05), and CD8 averaged 14% (6%), 4% (3%) and 4% (3%) in groups 1, 2 and 3 (p < 0.05). At 15 days after transplantation CD2 averaged 69% (10%), 42% (16%) and 47% (20%) in groups 1, 2 and 3 respectively (p < 0.05), and CD8 averaged 16% (7%), 16% (6%) and 19% (7%) (p = NS). At 30 days after transplantation the percentages of CD2, CD4 and CD8 lymphocytes were similar among the groups. The freedom rate from acute rejection averaged 22% (14%), 9% (8%) and 50% (18%) (p < 0.05) in groups 1, 2 and 3 at 6 months after transplantation, and the freedom rate from infection averaged 56% (17%), 36% (13%) and 38% (17%) for the 3 groups at this time period (p = NS). A short course of RATG causes severe, transitory depletion of CD2, CD4 and CD8 lymphocyte subpopulations. MMF decreases the incidence of early acute rejection after heart transplantation without affecting the lymphocyte subpopulation when compared with azathioprine.
ISSN:0008-428X
1488-2310