title: Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre-transplant diabetes.
abstract: Outcomes specifically in mycophenolate mofetil (MMF)-treated diabetic renal transplant patients have not been previously reported. This study compared acute rejection (AR), late acute rejection (LAR), patient survival [and specifically death from cardiovascular (CV), infectious and malignant causes], incidence of post-transplant malignancies, and graft loss in MMF- or azathioprine (AZA)-treated renal transplant patients with pre-transplant diabetes. Outcomes were compared between MMF- (n = 14 144) and AZA- (n = 3001) treated diabetic patients using the Scientific Registry of Transplant Recipients data on all U.S. adult renal transplants performed between 1995 and 2002. Statistical analyses included Kaplan-Meier survival analysis, Cox multivariable regression and chi-square tests. MMF patients had less AR compared with AZA-treated patients (23.5% vs. 28.3%, p < 0.001) and less risk for LAR over 4 yr [hazard ratio (HR): 0.64, 95% CI 0.44, 0.92; p = 0.02]. While time to any-cause death did not differ between the groups, MMF treatment was associated with a 20% decreased risk of CV death (HR: 0.80, 95% CI 0.67, 0.97; p = 0.020) compared with AZA treatment. MMF patients also had a lower incidence of malignancies than AZA patients (2.2% vs. 3.7%, p < 0.001). These results suggest treatment with MMF compared with treatment with AZA in diabetic transplant patients is associated with less AR, less risk of LAR, a decreased risk of CV death, and a lower incidence of malignancies.
authors.affiliation: ProSanos Corporation, La Jolla, CA, USA. kristin.david@prosanos.com
authors.forename: Kristin M
authors.initials: KM
authors.lastname: David
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Morris
authors.forename: Bettina J
authors.initials: BJ
authors.lastname: Steffen
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Chi-Burris
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Gotz
authors.forename: Robert D
authors.initials: RD
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use*; D044383:Black People / Q000706:statistics & numerical data; D002423:Cause of Death; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007239:Infections / Q000453:epidemiology / Q000401:mortality; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D007166:Immunosuppressive Agents; D007168:IMP Dehydrogenase; D009173:Mycophenolic Acid; D001379:Azathioprine