Analysis of Long Term Follow Up Result between Cycolosporine Based Azathioprine versus Mycophenolate Mofetil Groups Randomized after Renal Transplant

Park, Yo Han; Park, Kwan Tae; Kim, Song Cheol; Han, Duck Jong

Abstract

PURPOSE: Mycophenolate mofetil (MMF) has been used widely due to lesser acute rejection episode, better renal function and graft survival than azathioprine (AZA). But currently, there is controversy that which combination of immunosuppressants is most beneficial and cost-effective for renal transplant, because some authors reported MMF was related to more infectious complications and no actual superiority to AZA in aspect of graft survival. So, the aims of this study is to compare the long term outcome of renal transplants and the infectious complications between two groups treated with AZA and MMF in CSA based immunosuppressant treatment at our hospital.
METHODS
We retrospectively reviewed allograft recipients who had been transplanted from January of 1998 to July of 2000. 301 patients were enrolled (AZA=150/MMF=151) and analyzed for the incidence of acute rejection, infectious complication, renal function and graft survival.
RESULTS
Patients treated with MMF had fewer episodes of acute rejection (AR) within 3 months; 4/151 (2.6%) in MMF versus 15/150 (10%) in AZA (P=0.017), but after 3 months there was no difference in the incidence of AR. However, the patients treated with MMF had more infectious complications such as pneumonia, cytomegalovirus (CMV) infection, but there were no differences in urinary tract infection. There were also no differences in creatinine level at postoperative 1 week, discharge, 1 year, 3 year and 5 year. Graft survival and patient survival after 1 year and 5 showed no statistical differences between two groups.
CONCLUSION
MMF combined with CsA was more effective in the prevention of acute rejection within 3 months than AZA, but there was no long term significant difference in renal function, graft and patient's survival. Due to higher incidence of pneumonia and CMV infection in MMF group, it is necessary to choose the combination of immunosuppressants (AZA versus MMF) more appropriately considering efficacy of immunosuppression and infectious complication as well.