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Infectious complications in geriatric renal transplant patients: comparison of two immunosuppressive protocols
H U Meier-Kriesche1, G Friedman, M Jacobs
1Division of Renal Disease and Hypertension, The University of Texas at Houston Medical School, 77030, USA.
Background:
It has been well documented that a regimen of mycophenolate mofetil (MMF), cyclosporine (CsA), and prednisone (Pred) reduces the incidence of acute rejection in renal transplant recipients, as compared with previous regimens based on azathioprine (AZA), CsA, and Pred. In the general renal transplant patient population, immunosuppressive regimens that include MMF are usually well tolerated. It is not clear whether this holds true for older transplant recipients, who may be more susceptible to complications from the greater immunosuppression conferred by MMF.
Methods:
We retrospectively analyzed our geriatric renal transplant population (age >60 years, 1990-1998) and compared a cohort of 46 patients treated with AZA, Pred, and CsA to a cohort of 45 patients treated with MMF, Pred, and CsA.
Results:
There were no significant differences between the groups with regard to pretransplantation demographics. Patient and graft survival during the first year was not significantly different between the groups. During the first year of follow-up, we observed 27 infections requiring hospitalization in 15 patients in the MMF-treated group as compared with 10 infections in 7 patients in the AZA-treated group. A Cox proportional hazard model accounting for the above mentioned covariates isolated MMF versus AZA as a significant risk factor for the occurrence of serious infectious events (all: P<0.01; cytomegalovirus, fungal: P<0.01).
Conclusion:
We conclude that an immunosuppressive regimen of MMF, CsA, and Pred seems to be correlated with an increased incidence of infectious adverse events as compared with AZA, CsA, and Pred in elderly patients.
Insights
In elderly kidney transplant patients, mycophenolate mofetil (MMF) combined with other immunosuppressants increased serious infections compared to azathioprine (AZA). This suggests AZA may be safer for older recipients regarding infection risk.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Mycophenolate mofetil (MMF), cyclosporine (CsA), and prednisone (Pred) is a common renal transplant regimen.
- MMF-based immunosuppression is generally well-tolerated in the general population.
- Safety of MMF in elderly transplant recipients is not well-established due to potential increased susceptibility to immunosuppression-related complications.
Purpose of the Study:
- To compare the safety and efficacy of MMF-based immunosuppression versus azathioprine (AZA)-based immunosuppression in elderly renal transplant recipients (>60 years).
- To evaluate the incidence of infectious adverse events in this specific patient cohort.
Main Methods:
- Retrospective analysis of geriatric renal transplant patients (age >60 years) from 1990-1998.
- Comparison of a cohort of 46 patients treated with AZA, Pred, and CsA to a cohort of 45 patients treated with MMF, Pred, and CsA.
Main Results:
- No significant differences in pretransplantation demographics, patient, or graft survival between the MMF and AZA groups.
- The MMF group experienced a higher incidence of serious infections requiring hospitalization (27 infections in 15 patients) compared to the AZA group (10 infections in 7 patients).
- MMF was identified as a significant risk factor for serious infectious events, including cytomegalovirus and fungal infections (P<0.01).
Conclusions:
- An immunosuppressive regimen including MMF, CsA, and Pred is associated with a higher incidence of infectious adverse events compared to AZA, CsA, and Pred in elderly renal transplant recipients.
- Elderly patients may be at increased risk for infectious complications with MMF-based immunosuppression.
- This finding suggests a potential need for careful monitoring or alternative immunosuppressive strategies in older kidney transplant recipients.
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