title: Rescue immunosuppressive therapies in living-related renal allotransplant: a long-term prospective randomized evaluation.
abstract: OBJECTIVE
  The majority of our patients are maintained on prednisolone, cyclosporine, and azathioprine as primary immunosuppression. In the presence of repeated episodes of acute rejection, this maintenance immunosuppressive regimen is increased by replacing cyclosporine with tacrolimus or azathioprine with mycophenolate mofetil. To the best of our knowledge, there are no available data among living-related renal allotransplants that evaluate the long-term efficacy and safety of these rescue immunosuppressive therapies. Therefore, we sought to evaluate the long-term efficacy and safety of rescue immunosuppressive therapies among living-related renal allotransplant recipients.
  
  
  METHODS
  We reviewed the long-term follow-up data of 212 renal transplant recipients at the Urology and Nephrology Center Mansoura University in Mansoura, Egypt, who had been maintained on a primary immunosuppressive protocol that included prednisolone, cyclosporine, and azathioprine. Patients were randomized at a ratio of 1:2 to receive more-intensive maintenance immunosuppression by replacing cyclosporine with tacrolimus in 65 patients (group TAC) and replacing azathioprine with mycophenolate mofetil in 147 patients (group MMF).
  
  
  RESULTS
  We found no statistically significant difference between the 2 groups regarding rejection-free patients or those who experienced 1 or more episodes of acute rejection (P > .5). In group TAC and group MMF, graft survival rates were 87.3% and 96.3% at 2 years and 78.7% and 80% at 5 years, respectively (P = .07). The corresponding patient survival rates were 98.4% and 98.5% at 1 year, 98.4% and 97.7% at 2 years, and 94.4% and 94.4% at 5 years, respectively (P = .65%). There were more patients with diabetes and serious bacterial infections in group TAC than there were in group MMF (P = .001 and .04, respectively).
  
  
  CONCLUSIONS
  Conversion from cyclosporine to tacrolimus or from azathioprine to mycophenolate mofetil is a safe, equipotent rescue especially with repeated acute rejections. However, mycophenolate mofetil rescue therapy was more beneficial regarding graft survival.
authors.affiliation: Mansoura Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Mohemed Adel
authors.initials: MA
authors.lastname: Bakr
authors.forename: Osama Ashry
authors.initials: OA
authors.lastname: Gheith
authors.forename: Amani Mostafa
authors.initials: AM
authors.lastname: Ismael
authors.forename: Mahmoud El
authors.initials: ME
authors.lastname: Baz
authors.forename: Ahmed Bayomi
authors.initials: AB
authors.lastname: Shehab El-Dein
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus