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

Heo, Dong; Yoon, Yun Suk; Park, Min; Park, Yong Ki; Kim, Mi Sun; Kim, Joong Kyung

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.