Synergistic effect of mycophenolate mofetil and angiotensin-converting enzyme inhibitor in patients with chronic allograft nephropathy

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dc.contributor.authorMoscoso-Solorzano, G.t. [UNIFESP]
dc.contributor.authorMastroianni Kirsztajn, Gianna [UNIFESP]
dc.contributor.authorOzaki, K.s. [UNIFESP]
dc.contributor.authorFranco, Marcello Fabiano de [UNIFESP]
dc.contributor.authorPacheco-Silva, Alvaro [UNIFESP]
dc.contributor.authorCâmara, Niels Olsen Saraiva [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.date.accessioned2015-06-14T13:39:11Z
dc.date.available2015-06-14T13:39:11Z
dc.date.issued2009-05-01
dc.description.abstractExperimental data and few clinical non-randomized studies have shown that inhibition of the renin-angiotensin system by angiotensin-converting enzyme (ACE) associated or not with the use of mycophenolate mofetil (MMF) could delay or even halt the progression of chronic allograft nephropathy (CAN). In this retrospective historical study, we investigated whether ACE inhibition (ACEI) associated or not with the use of MMF has the same effect in humans as in experimental studies and what factors are associated with a clinical response. A total of 160 transplant patients with biopsy-proven CAN were enrolled. Eighty-one of them were on ACE therapy (G1) and 80 on ACEI_free therapy (G2). Patients were further stratified for the use of MMF. G1 patients showed a marked decrease in proteinuria and stabilized serum creatinine with time. Five-year graft survival after CAN diagnosis was more frequent in G1 (86.9 vs 67.7%; P < 0.05). In patients on ACEI-free therapy, the use of MMF was associated with better graft survival. The use of ACEI therapy protected 79% of the patients against graft loss (OR = 0.079, 95%CI = 0.015-0.426; P = 0.003). ACEI and MMF or the use of MMF alone after CAN diagnosis conferred protection against graft loss. This finding is well correlated with experimental studies in which ACEI and MMF interrupt the progression of chronic allograft dysfunction and injury. The use of ACEI alone or in combination with MMF significantly reduced proteinuria and stabilized serum creatinine, consequently improving renal allograft survival.en
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Hospital do Rim e Hipertensão Disciplina de Nefrologia
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Departamento de Patologia
dc.description.affiliationUniversidade de São Paulo Instituto de Ciências Biomédicas IV Departamento de Imunologia
dc.description.affiliationUnifespUNIFESP, Hospital do Rim e Hipertensão Disciplina de Nefrologia
dc.description.affiliationUnifespUNIFESP, Depto. de Patologia
dc.description.sourceSciELO
dc.format.extent445-452
dc.identifierhttp://dx.doi.org/10.1590/S0100-879X2009000500008
dc.identifier.citationBrazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 42, n. 5, p. 445-452, 2009.
dc.identifier.doi10.1590/S0100-879X2009000500008
dc.identifier.fileS0100-879X2009000500008.pdf
dc.identifier.issn0100-879X
dc.identifier.scieloS0100-879X2009000500008
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/5013
dc.identifier.wosWOS:000265286600008
dc.language.isoeng
dc.publisherAssociação Brasileira de Divulgação Científica
dc.relation.ispartofBrazilian Journal of Medical and Biological Research
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectRenin-angiotensin systemen
dc.subjectMycophenolate mofetilen
dc.subjectRenal allograft survivalen
dc.subjectKidney transplantationen
dc.titleSynergistic effect of mycophenolate mofetil and angiotensin-converting enzyme inhibitor in patients with chronic allograft nephropathyen
dc.typeinfo:eu-repo/semantics/article
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