A.E. de Weerd, M.J. Boer-Verschragen, E.J. Hoorn, M.G.H. Betjes
Chair(s): dr. Arjan van Zuilen, UMCU
Thursday 10 march 2016
13:30 - 14:00h at Foyer
Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)
Mycophenolate mofetil (MMF) markedly decreases blood pressure in rats1. Human data on renal immune cell infiltration in hypertension are scarce and observational but indicate that similar mechanisms may be operative 2. Discontinuation of MMF in a randomized fashion in stable kidney transplant patients provides an excellent opportunity to study the effects of MMF on blood pressure.
In 2014 the TacMono study was started with the objective to randomize 80 low-risk kidney transplant recipients (≤3 HLA mismatches and ≤4% panel reactive antibodies) to either continue tacrolimus/ MMF or half their MMF dose at month 6 followed by MMF discontinuation at month 9. Hence, after nine months the latter group of patients are treated with once daily slow release tacrolimus (Advagraf) as the only immunosuppressive drug. Blood pressure is measured 6, 9 and 12 months after transplantation. The mean arterial pressure (MAP) of the last 6 out of 7 30-minute-Datascoop recordings were analyzed. Per patient the percentage change in blood pressure compared to baseline MAP was calculated. The change in MAP over time was corrected for the use of antihypertensive drugs using the WHO daily defined dose (DDD). Mann-Whitney U testing was used to analyze differences between the two groups.
Till November 2015, 17 patients have been randomized of which 11 have completed nine months and 7 patients twelve months follow-up. Median MMF dose at randomization was 1000 mg daily. Median MAP at randomization was 98 mmHg (range 87-124,5). Decreasing MMF did not alter blood pressure levels: the MAP decreased 4% after dividing the MMF dose in half (controls 5% increase) and returned to baseline randomization levels after discontinuation of MMF (controls 7% increase), both p >0,1. In 7 patients the antihypertensive regimen was changed during the study period: in TacMono patients no net change in cumulative DDD was observed after nine and twelve months (median use 2,83 DDD at baseline), while in standard dual therapy no net change was observed after nine months and 50% increase after twelve months (median use 2,50 DDD at baseline).
Our preliminary results indicate that MMF in clinically relevant dosages does not influence blood pressure in kidney transplant patients. 1 Boesen, Clin Exp Pharmacol Physiol 2010. 2 Herrera, J Am Soc Nephrol 2006.