title: Mycophenolate mofetil use is associated with prolonged graft survival after kidney transplantation.
abstract: BACKGROUND
  Mycophenolate mofetil has replaced azathioprine in many transplant centers, but data on hard outcomes such as graft and patient survival are lacking.
  
  
  METHODS
  We analyzed graft and patient survival of the 1219 first renal allograft recipients at the Medical University of Vienna who were treated with azathioprine or mycophenolate mofetil over the past decade. Cox's proportional hazards models were used to compute crude and confounder-adjusted hazard ratio estimates of azathioprine versus mycophenolate mofetil. Model building was performed by applying the purposeful selection algorithm, confounding by indication was addressed by propensity scores and marginal structural models.
  
  
  RESULTS
  Five years after transplantation, 12% of mycophenolate mofetil users experienced functional graft loss whereas 26% of the azathioprine users had lost their graft (P<0.001). The hazard ratio for functional graft loss was 2.15 (95% confidence interval 1.16-4.02, P=0.016) in azathioprine versus mycophenolate mofetil patients. Actual graft loss at five years had occurred in 25% of the mycophenolate mofetil patients and 49% of the azathioprine users (P<0.001); hazard ratio 2.04 (95% confidence interval 1.22-3.39, P=0.006). Patient survival was not different in any of the analyses.
  
  
  CONCLUSIONS
  The data from our observational study suggest that mycophenolate mofetil use was associated with a lower risk of graft loss than azathioprine-based immunosuppression.
authors.affiliation: Department of Nephrology, KH Elisabethinen, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kainz
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Réka
authors.initials: R
authors.lastname: Korbély
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarz
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
mesh_terms: D000465:Algorithms; D001317:Austria; D001379:Azathioprine / Q000627:therapeutic use*; D005060:Europe; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine