Five-year outcome in pediatric patients with mycophenolate mofetil-based renal transplantation.
BACKGROUND
Mycophenolate mofetil (MMF) based immunosuppression after renal transplantation has proven to be safe and beneficial for children and adolescents. However, long-term analysis, in particular of pediatric patients, is scarce.


METHODS
Data of 140 patients receiving MMF versus azathioprine (AZA) in combination with cyclosporine A (CsA) and prednisone without induction were analyzed with a main focus on survival and renal function in long-term follow-up.


RESULTS
After 5 years of follow-up, 44 MMF and 20 AZA patients were still on study. Graft survival of intent to treat (ITT) groups was 90.7% for MMF and 68.5% for AZA patients (P<0.001). Cumulative rejection free survival was 51.2% in MMF versus 37.0% in AZA patients (P<0.05). In association with early acute rejections (ARE), projected half-life was 14.4/4.5 years in patients with and 18.7/14.5 years without rejection in the MMF/AZA group, respectively.


CONCLUSIONS
MMF based protocols improved long-term graft survival without an increase in side effects. Early ARE were associated with worse half-life of the graft, although more stressed in the AZA group. Thus, to improve quality of life in children for very long-term outcome, ARE should be further decreased and renal function should be better preserved.
Jungraithmayr
Therese C
TC
1 Universitätsklinik für Kinder und Jugendheilkunde, Innsbruck, Austria.
Wiesmayr
Silke
S
Staskewitz
Astrid
A
Kirste
Günter
G
Bulla
Monika
M
Fehrenbach
Henry
H
Dippell
Jürgen
J
Greiner
Christel
C
Griebel
Martin
M
Helmchen
Udo
U
Klaus
Günter
G
Leichter
Heinz E
HE
Mihatsch
Michael J
MJ
Michalk
Dietrich V
DV
Misselwitz
Joachim
J
Plank
Christian
C
Tönshoff
Burkhard
B
Weber
Lutz T
LT
Zimmerhackl
Lothar B
LB
D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010352:Patient Dropouts / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine