Long-term graft outcome with mycophenolate mofetil and azathioprine: A paired kidney analysis.
BACKGROUND
Randomized controlled trials and U.S. Registry data have demonstrated that mycophenolate mofetil (MMF) reduces acute rejection rates and improves graft survival. We undertook the first paired kidney analysis comparing the effects of MMF and azathioprine on graft outcome in the United Kingdom.


METHODS
In all, 238 deceased donors from 1999 to 2002 who donated one kidney to a patient treated with MMF and the other kidney to a patient treated with azathioprine were identified from the national transplant database held by U.K. Transplant. Graft function and rates of change of graft function were compared using multiple linear regression analyses adjusting for covariates on an intention-to-treat basis. Incidence of acute rejection and delayed graft function were studied using logistic regression. Patient and graft survival censored for death were evaluated with Cox regression analyses.


RESULTS
The MMF-treated patients exhibited a nonsignificant trend towards improved graft function but with increased rejection rates (44% versus 31%, P < 0.01). Treatment with MMF did not reduce delayed graft function rates. Univariate analysis showed that graft survival was inferior in MMF-treated patients (90% versus 95%, log-rank, P = 0.02) but in multivariate Cox regression models, MMF treatment was not a significant factor. Surprisingly, in the first year 32% of patients achieved daily doses of less than 2 g of MMF compared to 18% of patients who received less than 100 mg of azathioprine (P < 0.01).


CONCLUSIONS
In this real-life study, there was no difference in patient or graft outcome between MMF and azathioprine treated groups despite increased rejection rates in patients receiving MMF therapy.
Shah
Sapna
S
Department for Experimental Medicine, Nephrology, and Critical Care, William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom. sapna.shah100@hotmail.com
Collett
Dave
D
Johnson
Rachel
R
Thuraisingham
Raj C
RC
Raftery
Martin J
MJ
Rudge
Chris J
CJ
Yaqoob
Muhammad M
MM
D001379:Azathioprine / Q000008:administration & dosage*; D033001:Directed Tissue Donation; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014019:Tissue Donors; D016896:Treatment Outcome; D006113:United Kingdom
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine