title: Infections in renal transplant recipients receiving mycophenolate versus azathioprine-based immunosuppression.
abstract: Differences in the incidence, etiology, type, and outcome of infections occurring during the first 6 months after transplantation were evaluated in two consecutive cohorts of kidney recipients who received immunosuppressive regimens based on either azathioprine (plus antilymphocyte globulin, cyclosporine A, and prednisone) (ATG-AZA cohort) or mycophenolate-mofetil (plus cyclosporine A and prednisone) (MMF cohort). The overall incidence of infections in the two cohorts was similar (0.99+/-1.06 infections/patient in the MMF cohort and 1.04+/-0.99 in the ATG-AZA cohort, P=0.3), as was the incidence of bacterial and fungal infections. In patients who received mycophenolate, cytomegalovirus disease occurred at a higher incidence (0.3+/-0.54 vs. 0.1+/-0.34 episodes/patient, P=0.005) and affected the upper gastrointestinal tract more frequently (0.21+/-0.48 vs. 0.025+/-0.16 episodes of cytomegalovirus ulcerative esophagitis, gastritis, or duodenitis per patient; P=0.001). A nonsignificant trend toward a higher recipient survival for patients receiving mycophenolate was noted (100% vs. 95%, P=0.07). In multivariate analysis, the following factors were independently associated with a higher risk of cytomegalovirus disease: the serostatus R-/D+ (seronegative recipients who received a kidney from a seropositive donor) (RR=35.7 [95%CI, 7.4-166.7]), treatment with mycophenolate (RR=10.4 [95%CI, 2.7-38.4]), and the development of any episodes of acute rejection (RR=10.1 [95%CI, 2.5-41.6]). These data show that kidney recipients receiving mycophenolate have a higher incidence of cytomegalovirus disease, mainly affecting the upper gastrointestinal tract, compared to those receiving azathioprine-based immunosuppression.
authors.affiliation: Service of Infectious Diseases, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013 Seville, Spain. wittel@cica.es
authors.forename: M
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.forename: M
authors.initials: M
authors.lastname: Naranjo
authors.forename: J M
authors.initials: JM
authors.lastname: Cisneros
authors.forename: E
authors.initials: E
authors.lastname: Cañas
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.forename: G
authors.initials: G
authors.lastname: Algarra
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.forename: F J
authors.initials: FJ
authors.lastname: González-Roncero
authors.forename: A
authors.initials: A
authors.lastname: de Alarcón
authors.forename: J
authors.initials: J
authors.lastname: Pachón
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects*; D001424:Bacterial Infections / Q000150:complications*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects* / Q000031:analogs & derivatives*; D009181:Mycoses / Q000150:complications*; D009894:Opportunistic Infections / Q000150:complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine