title: Successful rescue therapy with mycophenolate mofetil in kidney transplantation improves the long-term graft survival.
abstract: OBJECTIVE
  The aim of this study was to compare the graft survival after kidney transplantation in patients treated with azathioprine (AZA) or mycophenolate mofetil (MMF) and analyze the significance of different risk factors for graft survival.
  
  
  METHODS
  A total of 137 patients, transplanted between January 1996 and June 2001, were retrospectively divided into two groups: patients who received AZA together with cyclosporine A and methylprednisolone (AZA group, n=72) and patients who received MMF either immediately or were switched from AZA to MMF during 3 months (MMF group, n=65).
  
  
  RESULTS
  According to Kaplan-Meier analysis, a 1-year graft survival was 79% in the AZA group and 85% in the MMF group; a 6-year graft survival was 51% and 67%, respectively (P=0.046). Multivariate Cox survival model demonstrated that MMF therapy reduced the risk of graft loss by 34% (P=0.028), while delayed graft function increased the risk of graft loss (risk ratio 2.26, P=0.009). A statistically significant difference in total cholesterol level (6.7 vs. 5.7 mmol/L, respectively; P=0.002), mean systolic blood pressure (145 vs. 134 mmHg, P=0.009), and cyclosporine A daily dose (238 vs. 203 mg, P=0.015) between the AZA and MMF groups at 1 year was revealed.
  
  
  CONCLUSIONS
  MMF rescue therapy improves the long-term graft survival compared to AZA despite high early rejection rate and avoids the negative impact of acute rejections on graft survival.
authors.affiliation: Department of Urology and Kidney Transplantation, Clinic of Surgery, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia. jaanus.kahu@kliinikum.ee
authors.forename: Jaanus
authors.initials: J
authors.lastname: Kahu
authors.forename: Aleksander
authors.initials: A
authors.lastname: Lõhmus
authors.forename: Madis
authors.initials: M
authors.lastname: Ilmoja
authors.forename: Ulle
authors.initials: U
authors.lastname: Kirsimägi
authors.forename: Gennadi
authors.initials: G
authors.lastname: Timberg
authors.forename: Ants
authors.initials: A
authors.lastname: Peetsalu
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D002102:Cadaver; D016022:Case-Control Studies; D016572:Cyclosporine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine