May 19, 1999 A kidney transplant offers people with kidney failure a new chance at a normal, active life. But, on average, a transplanted kidney continues to function for only nine years. Now, doctors at the University of Maryland Medical Center say a new strategy to extend the function of transplanted kidneys shows promise.
In a study of 60 people who had received kidney transplants and were showing signs of kidney deterioration, University of Maryland researchers found that they could improve the kidney function in the majority of patients by cutting in half the dose of cyclosporine (Neoral), a widely used drug to prevent rejection, and adding a new anti-rejection drug mycophenolate mofetil (CellCept). The findings will be presented at the American Society of Transplantation meeting in Chicago on May 16.
Although both drugs prevent the body's rejection of the new kidney by suppressing the patient's immune system, they work in different ways, and therefore may have a different effect on transplanted kidneys over time. "Many kidney transplant patients, especially those whose kidneys came from cadaver donors, experience a slow but steady deterioration of function of their new kidney. Before, we had no proven way to intervene. We have been trying to develop new strategies to prevent kidney dysfunction or at least slow it down," says Matthew Weir, M.D., professor of medicine and head of the division of Nephrology at the University of Maryland School of Medicine.
"We are encouraged that with our new strategy, we saw an improvement in kidney function in 37 of the patients we studied, over an average time span of two years after starting the new drug combination. It means we can have an impact," adds Dr. Weir.
After an organ transplant, all patients need to take medications the rest of their lives to prevent their body's immune system from attacking the new organ and destroying it. However, these anti-rejection drugs can also cause side effects and impair the functioning of the new kidney over time. Other factors that threaten the long-term functioning of a new kidney include high blood pressure and high glucose and cholesterol levels.
Dr. Weir says careful monitoring and follow up are needed for all kidney transplant recipients, so that adjustments can be made in medication. Changes in kidney function are subtle and can only be detected at an early stage with urine and blood tests.
Members of the University of Maryland Medical Center transplant team are so encouraged by their findings that the new therapeutic strategy is being used in all kidney transplant patients who experience erosion of their kidney function. The study was funded in part by Hoffman-La Roche, Inc., which makes CellCept. The University of Maryland Medical Center has the second busiest kidney transplant program in the U.S.
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