Mycophenolate Mofetil Versus Azathioprine in Cyclosporine Based Triple Immunosuppression

Kim, Seung Cheol; Han, Duck Jong; Kim, Tae Hee; Kim, Song Cheol

Abstract

PURPOSE: Recent studies have demonstrated improved outcome in renal transplant recipients treated with mycophenolate mofetil (MMF). We compared the outcome of allograft treated with MMF versus AZA in CsA/prednisolone based immunosuppressant treated renal transplant at our center.
METHODS
We retrospectively reviewed allograft recipients who had been transplanted from Jan. to Dec. 1998 in AZA group (n=87) and Jan. to Dec. 1999 in MMF group (n=99). The variables of donor and recipient as well as the survival factors were compared between the two groups. And the adverse effects of MMF and AZA were analyzed. Duration of follow-up was one year, respectively.
RESULTS
Between the two groups, there were no significant differences in sex, age, type of donor, ABO and HLA mismatches. Patients treated with MMF and CsA had significantly fewer episodes of rejection; 5/99 (5.1%) in MMF versus 13/87 (14.9%) in AZA (P<0.05). In the MMF group, patients with higher dose (1.5 g/d) had lower rejection rate than those with lower dose, illustrating the dose dependant immunosuppressive effect. However one-year allograft survival did not show any significant difference between two groups (96.9% in MMF versus 97.7% in AZA). Gastrointestinal symptoms such as diarrhea were more common in MMF group but hepatotoxicity and leukopenia were more prevalent in AZA group.
CONCLUSION
While the one-year graft survival following renal transplantation was similar between the MMF and AZA group, lower rejection rate in MMF group suggests the favorable long term graft survival with MMF.