Cardiovascular Journal of Africa: Vol 26 No 3 (May/June 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015

108

AFRICA

were decreased during MMF therapy. This study suggested that

MMF therapy regulates the activation markers in B lymphocytes

while decreasing B lymphocyte counts.

A total of 22 orthotopic heart transplantations were

performed between April 1995 and February 2002 in the Onasis

Cardiac Surgery Centre.

Within this period, 532 patients were

selected and 223 were approved for pre-transplantation. AZA,

CYC and steroids were used for initial immunosuppression, with

MMF used instead of AZA in 16 patients. Gradually, AZA has

been completely replaced by MMF in cases that have exceeded

three years post transplant. A total of 19 patients were followed

for more than one year after transplantation and it was found

that one (5.3%) patient died, three (15.8%) developed rejection

and three (15.8%) coronary artery disease.

Klupp

et al.

divided rats that underwent allograft heart

transplantation into four groups, each including six rats. Each of

the groups receiving low- or high-doseMMFwas divided into two

subgroups. Pharmacokinetics (measured by high-performance

liquid chromatography), pharmacodynamics and histological

graft rejection scoring were performed in all animals on the

sixth day. Rejection scoring was found to be more associated

with MPA plasma concentration in terms of suppression of

lymphocyte proliferation and transferrin receptor expression.

Good lymphocyte suppression was provided in the low-dose

group (5 mg/kg MMF BID) and ongoing pharmacodynamics

were also good. No difference was found between low- and high-

dose groups in terms of rejection scores.

In initial clinical studies, MMF has been used instead of AZA

in triple therapies. In a randomised study comprising 50 patients

from 28 centres, MMF was compared with AZA in triple therapy

after cardiac transplantation. It was found that the need for

rejection therapy was decreased and the one-year mortality rate

was substantially reduced in the MMF group.

Pethig

et al.

investigated systemic inflammatory response in

patients who had undergone heart transplantation and had been

receiving immunosuppressive agents containing AZA or MMF.

Systemic inflammatory response was found to be lower in the

MMF group. High-quality, randomised studies have demonstrated

that MMF, when used together with CYC and steroids, reduced

the frequency and intensity of rejection and improved the grafts,

in patients who underwent heart and kidney transplantation.

A limitation of our

study was that the number of study

subjects was low. Also the efficacy of MMF was investigated

compared with only MP, but not with a control group. Since

MP is an immunosuppressive agent approved by the scientific

population, it was selected instead of placebo.

Conclusion

This study compared the effects of MMF and MP on duration

of motor activity and rejection rate of transplants in rabbits that

underwent retroperitoneal heterotopic heart transplantation. We

found that MMF caused statistically significantly longer duration

of motor activity in the transplanted hearts. No statistically

significant difference was found between the MMF and MP

groups in terms of transplant rejection rate. However, based on

the absence of a significant difference with MP, which is a potent

and important immunosuppressive agent in rescue therapy in

terms of prevention of rejection, we concluded that MMF is also

important for the prevention of rejection in transplantation.

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