Long Term Maintenance Immunosuppressive Therapy with Mycophenolate Mofetil and Steroid after Kidney Transplantation

ABSTRACT

PURPOSE: Cyclosporine associated hemolytic uremic syndrome (HUS) is a serious complications following kidney transplantation. In this study, 2 renal transplant patients, treated by the dual drugs -Mycophenolate Mofetil (MMF) and steroid (Deflazacort), without cyclosporine- due to development of HUS, were followed-up. Additionally, IFN-gamma and IL-10 as Th1 and Th2 cytokines, respectively, and their serum levels investigated. METHODS: Following their recovery from HUS, the 2 patients have been followed for 37 and 45 months, respectively, with MMF and steroid as maintenance immunosuppressants. The serum IFN-gamma and IL-10 levels were measured simultaneously in the 2 patients on dual drug, 10 on triple drug (cyclosporine, MMF, steroid) therapies and 18 normal volunteers. The 10 patients on the triple drug therapy were selected from 14 patients, that had undergone renal transplantations in the same year as the 2 dual drug therapy patients. RESULTS: At 37 and 45 months post-transplantation, the 2 pdual drug therapy patients showed serum creatinine levels less than 1.8 and 1.7 mg/dl, respectively. The serum IFN-gamma and IL-10 levels of the 12 (2 dual and 10 triple drug therapy) renal transplant patients (11.83+/-5.01 and 5.96+/-6.02 pg/ml, respectively) were significantly higher than those of the 18 normal volunteers (7.25+/-0.84 and 1.40+/-0.81 pg/ml, respectively), (IFN-gamma P=0.000, IL-10 P=0.000). However a comparison of IFN-gamma and IL-10 levels between the 2 dual(11.56+/-3.35 and 4.91+/-1.66 pg/ml, respectively) and 10 triple drug therapy patients (11.89+/-5.43 and 6.17+/-6.61 pg/ml, respectively) showed no significant difference (IFN-gamma P=0.606, IL-10 P=0.485). CONCLUSION: Long-term maintenance treatment with MMF and steroid is an effective alternative therapy in case of cyclosporine induced HUS.