Department of Internal Medicine I, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany.
Kidney Blood Press Res. 2010;33(1):52-9. doi: 10.1159/000289573. Epub 2010 Mar 2.
BACKGROUND/AIMS: Despite improved efficacy, modern immunosuppressive agents may show unanticipated side effects. In this study we investigated the possible interactions of mycophenolate mofetil (MMF) with wound healing and lymphocele formation.
We conducted a retrospective single-center analysis in 144 patients receiving a cyclosporine A-based immunosuppression with prednisolone and either MMF (n = 77) or azathioprine (AZA, n = 77). Endpoints were incidences of lymphocele formation and non-primary wound healing during 6 months' follow-up.
AZA-treated patients had more rejection episodes and consecutively more steroid pulses, both being potential risk factors for endpoints. No graft was lost in any group and graft function was comparable. AZA patients demonstrated a trend for more frequent wound infections. Fluid accumulation around the graft, however, was more frequent in the MMF group (OR = 2.6; p = 0.03). Consequently, more drainage maneuvers (17 vs. 5 interventions) and sclerotherapies (8 vs. 0 interventions) were undertaken in MMF patients. Pre-assigned risk factors for lymphoceles reported before did not differ between both cohorts; patients experiencing acute rejection episodes had even less symptomatic lymphoceles (n = 23).
We found a possible relationship between the administration of MMF and lymphocele formation. To avoid the hazard of reinterventions, the prolongation of hospitalization and impairment of graft function, it requires awareness and attention in patients treated with this immunosuppressant.
背景/目的：尽管现代免疫抑制剂的疗效有所提高，但它们可能会表现出意想不到的副作用。在这项研究中，我们研究了霉酚酸酯（MMF）与伤口愈合和淋巴囊肿形成之间可能存在的相互作用。
我们对 144 名接受环孢素 A 为基础的免疫抑制治疗的患者进行了回顾性单中心分析，这些患者接受泼尼松龙治疗，并分别接受 MMF（n = 77）或硫唑嘌呤（AZA，n = 77）治疗。终点是 6 个月随访期间淋巴囊肿形成和非原发性伤口愈合的发生率。
AZA 治疗组的排斥反应发生率更高，随后皮质类固醇脉冲治疗的次数也更多，这两者都是终点的潜在危险因素。在任何一组中都没有失去移植物，并且移植物功能相当。AZA 患者的伤口感染更频繁，但在 MMF 组中，液体在移植物周围积聚的情况更为频繁（OR = 2.6；p = 0.03）。因此，MMF 患者需要进行更多的引流操作（17 次与 5 次干预）和硬化治疗（8 次与 0 次干预）。之前报告的与淋巴囊肿相关的预先指定的危险因素在两组之间没有差异；经历急性排斥反应的患者的症状性淋巴囊肿更少（n = 23）。
我们发现 MMF 的给药与淋巴囊肿形成之间可能存在关系。为了避免再次干预的危险、延长住院时间和损害移植物功能，在接受这种免疫抑制剂治疗的患者中，需要提高认识并加以关注。
