Comparison of Prevention for Acute Rejection in Renal Transplantation between Mycophenolate Mofetil(MMF) and Azathioprine / 대한신장학회잡지

ABSTRACT

BACKGROUND: Acute renal allograft rejection is not only risk factor of chronic rejection but is also a significant cause of graft loss and patient death. MMF has been shown to reduce the incidence and severity of acute rejection. METHODS: To compare the risk of acute rejection and side effects of MMF with azathioprine(AZA), a total of 108 patients, who received living transplants, were divided in two groups MMF(n=48) and AZA group(n=60). Cyclosporin microemulsion(Neoral) and steroid were administered concomitantly to all patients. RESULTS: The MMF group was significantly lower rate of acute rejection compared with AZA group during the first 3 months after renal transplantation(14.6% vs 30.0%, p=0.005). 54.5% of patients in the MMF group and 44% in the AZA group were treated only with steroid pulsing for acue rejection. 45.5% in the MMF group, compared to 56% in the AZA group, required OKT3 or Atgam for treatment of severe acute rejection, the difference is not significant. Treatment failure occurred among 31.3% of the MMF group compared with 55% in the AZA group(p=0.013). Serum creatinine of 6 months after transplantation was significantly lower in the MMF group than in the others(1.31+/-.27 vs 1.50+/-.28 mg/dL, p=0.017). The incidence of opportunistic infection was similar in both groups. Gastrointestinal side effects were more common in the MMF group 14.6% than in the AZA group 3.3%(p=0.035), while leukopenia was more common in the AZA group 21.7% than in the MMF group 4.3%(p=0.017). CONCLUSION: MMF reduced the incidence of acute rejection without notable side effects. Long-term follow up will be needed to establish the protective effect of MMF against immunological attack.