title: Five-year outcome in pediatric patients with mycophenolate mofetil-based renal transplantation.
abstract: 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.
authors: 1 Universitätsklinik für Kinder und Jugendheilkunde, Innsbruck, Austria.
authors: Therese C
authors: TC
authors: Jungraithmayr
authors: Silke
authors: S
authors: Wiesmayr
authors: Astrid
authors: A
authors: Staskewitz
authors: Günter
authors: G
authors: Kirste
authors: Monika
authors: M
authors: Bulla
authors: Henry
authors: H
authors: Fehrenbach
authors: Jürgen
authors: J
authors: Dippell
authors: Christel
authors: C
authors: Greiner
authors: Martin
authors: M
authors: Griebel
authors: Udo
authors: U
authors: Helmchen
authors: Günter
authors: G
authors: Klaus
authors: Heinz E
authors: HE
authors: Leichter
authors: Michael J
authors: MJ
authors: Mihatsch
authors: Dietrich V
authors: DV
authors: Michalk
authors: Joachim
authors: J
authors: Misselwitz
authors: Christian
authors: C
authors: Plank
authors: Burkhard
authors: B
authors: Tönshoff
authors: Lutz T
authors: LT
authors: Weber
authors: Lothar B
authors: LB
authors: Zimmerhackl
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine