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Mycophenolate mofetil vs azathioprine in a large population of elderly renal transplant patients

Herwig-Ulf Meier-Kriesche1, Jonathan A Morris, Alice H Chu

  • 1Division of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA. meierhu@medicine.ufl.edu

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|October 22, 2004
PubMed
Abstract

Insights

Mycophenolate mofetil (MMF) improves kidney transplant outcomes in elderly patients, reducing late acute rejection and enhancing patient and graft survival compared to azathioprine (AZA). This study found no increased risk of death with MMF use.

Area of Science:

  • Nephrology
  • Immunosuppression Therapy
  • Transplantation Research

Background:

  • Mycophenolate mofetil (MMF) is known to reduce acute rejection and improve survival post-kidney transplant compared to azathioprine (AZA).
  • Concerns exist regarding a potential increased risk of infection-related death in elderly patients receiving MMF-based immunosuppression.

Purpose of the Study:

  • To evaluate the efficacy and safety of MMF versus AZA in elderly primary renal allograft recipients.
  • To compare rates of acute rejection, graft survival, and patient survival between MMF and AZA treatment groups.

Main Methods:

  • Analysis of 5069 elderly (>65 years) primary renal allograft recipients from 1988-2000.
  • Comparison of outcomes including acute rejection, graft survival, and patient survival between MMF and AZA treatment groups using Cox proportional hazard models and Kaplan-Meier analysis.

Main Results:

  • MMF was associated with significantly lower rates of late acute rejection at 24 months (RR = 0.50, P = 0.028).
  • Kaplan-Meier analysis showed MMF significantly improved patient (P = 0.0003) and graft (P<0.0001) survival compared to AZA.
  • Multivariate analyses indicated trends toward improved patient and graft survival with MMF.

Conclusions:

  • MMF-based immunosuppression is effective in elderly kidney transplant recipients.
  • The study did not find an increased risk of death in elderly recipients treated with MMF compared to AZA.

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