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Changing treatment protocol from azathioprine to mycophenolate mofetil: decrease in renal dysfunction, increase in

V Pourfarziani1, Y Panahi, S Assari

  • 1Nephrology/Urology Research Center (NURC), Kidney Transplant Department, Baqiyatallah Medical Sciences University, Tehran, Iran. vahid.pourfarziani@gmail.com

Transplantation Proceedings
|May 26, 2007
PubMed
Abstract

Insights

The shift from azathioprine (AZA) to mycophenolate mofetil (MMF) improved kidney transplant survival but increased infection-related hospitalizations. Careful monitoring is crucial for patients on MMF to manage these risks.

Area of Science:

  • Nephrology
  • Immunosuppression
  • Transplantation Medicine

Background:

  • Renal transplantation immunosuppression protocols have evolved from azathioprine (AZA) to mycophenolate mofetil (MMF).
  • This transition aimed to improve patient and graft outcomes post-kidney transplant.
  • Understanding the impact on rehospitalization causes is critical for optimizing care.

Purpose of the Study:

  • To compare the impact of azathioprine (AZA) versus mycophenolate mofetil (MMF) immunosuppression on rehospitalization causes.
  • To evaluate differences in patient and graft survival between AZA and MMF cohorts.
  • To analyze post-transplant admission data, including reasons, timing, and critical care needs.

Main Methods:

  • Retrospective cohort study of 893 kidney transplant recipients.
  • Comparison of 289 patients on AZA (1998-1999) versus 567 patients on MMF (2000-2001).
  • Analysis of long-term survival, rehospitalization rates, causes, ICU admissions, and mortality.

Main Results:

  • Five-year patient survival improved from 85% (AZA) to 91% (MMF) (P=.013).
  • MMF cohort showed significantly fewer rejections (35% vs 62%) but more infections (50% vs 37%) compared to AZA.
  • Marginally increased mortality (5% vs 2%) and ICU admission (6% vs 3%) observed in the MMF group.

Conclusions:

  • Mycophenolate mofetil (MMF) offers improved graft survival over azathioprine (AZA) in kidney transplantation.
  • The shift to MMF is associated with a significant increase in infection-related rehospitalizations.
  • While beneficial, MMF necessitates vigilant management to mitigate risks of infectious complications.

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