title: Changing treatment protocol from azathioprine to mycophenolate mofetil: decrease in renal dysfunction, increase in infections.
abstract: BACKGROUND
  Immunosuppression for renal transplantation has shifted from azathioprine (AZA) regimens to those containing mycophenolate mofetil (MMF). This study investigated the impact of this change on the causes for rehospitalization as well as on graft and patient survival.
  
  
  METHODS
  In this retrospective cohort study, we reviewed long-term patient and graft survivals as well as the causes of posttransplant admissions for 893 kidney recipients. Data on survival and readmissions were available for 811 subjects, who were divided to into the AZA cohort (n=289, transplantation between 1998 and 1999) and the MMF cohort (n=567, transplantation between 2000 and 2001). Survival, the cause for readmission, time interval between transplantation and readmission, intensive care unit (ICU) admission, mortality, and graft loss were compared between the two cohorts.
  
  
  RESULTS
  Five-year patient and graft survival rates were 85% and 67% for the AZA cohort and 91% and 68% for the MMF cohort (P=.013). There were 202 (71%) and 371 (72%) readmissions registered for the AZA and MMF groups, respectively. In comparison with the AZA cohort, while readmissions secondary to graft rejection showed a significant decrease in the MMF cohort (62% vs 35%, P=.000), readmissions secondary to infections exhibited a significant increase (37% vs 50%, P=.002). A marginally significant increased mortality rate (2% vs 5%, P=.087) and ICU admission rate (3% vs 6%, P=.062) were also observed in the MMF cohort by comparison with the AZA cohort.
  
  
  CONCLUSIONS
  The shift in the immunosuppression protocol from AZA to MMF, albeit advantageous in many instances, can sometimes undermine the outcome by giving rise to such complications as high infection rates.
authors.affiliation: Nephrology/Urology Research Center (NURC), Kidney Transplant Department, Baqiyatallah Medical Sciences University, Tehran, Iran. vahid.pourfarziani@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Pourfarziani
authors.forename: Y
authors.initials: Y
authors.lastname: Panahi
authors.forename: S
authors.initials: S
authors.lastname: Assari
authors.forename: M
authors.initials: M
authors.lastname: Moghani-Lankarani
authors.forename: S-H
authors.initials: SH
authors.lastname: Saadat
mesh_terms: D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003140:Communicable Disease Control; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D017211:Treatment Failure
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine