Abstract
There have been several retrospective studies indicating benefits associated with mycophenalate mofetil (MMF) compared to azathioprine (AZA) for renal transplant recipients. However, these analyses evaluated outcomes prior to changes in utilization patterns of concomitant immunosuppression. Recent prospective trials have indicated similar outcomes among patients treated with MMF and AZA. The aim of this study was to evaluate outcomes in a broad group of patients in the more recent era. We evaluated adult solitary renal transplant recipients from 1998 to 2006 with the national SRTR database. Primary outcomes were time to patient death and graft loss, complications and renal function. Models were adjusted for potential confounding factors, propensity scores and stratified between higher/lower risk transplants and concomitant immunosuppression. Adjusted models indicated a modest risk among AZA patients for graft loss (AHR = 1.14, 95% CI 1.07-1.20); however, this was not apparent among AZA patients also treated with tacrolimus (AHR = 0.97, 95% CI 0.85-1.11]. One-year acute rejection rates were reduced for patients on MMF versus AZA (10 vs. 13%, p < 0.01); there were no statistically significant differences of malignancies, renal function or BK virus at 1 year. The primary findings suggest the association of MMF with improved outcomes may not be apparent in patients also receiving tacrolimus.
Original language | English (US) |
---|---|
Pages (from-to) | 2067-2074 |
Number of pages | 8 |
Journal | American Journal of Transplantation |
Volume | 9 |
Issue number | 9 |
DOIs | |
State | Published - Sep 2009 |
Externally published | Yes |
Keywords
- Azathioprine
- Cyclosporine
- Graft survival
- Immunosuppression
- Mycophenolate mofetil
- Tacrolimus
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)