Conversion from azathioprine to mycophenolate mofetil in patients with kidney transplantation taking triple drug immnosuppression

Hippokratia 2002, 6(4):177-185

G. Vergoulas, Miserlis, I Fouzas, G Trellopoulos, V. Papanikolaou, D. Gakis


The purpose of this study was to evaluate the effect and safety of azathioprine (AZA) replacement with mycophenolate mofetil (MMF) in a triple drug immunosuppression protocol on kidney transplant recipients. Fifty patients (35 men), 34 year – old (range 15-60 years) were included in the study. The replacement of AZA with MMF was done 5.24 ±2.43 years from transplantation (range 1.47 – 10.56 years) because of a serum creatinine rise and / or proteinuria. The patients had received triple or quadruple induction therapy with Cyclosporine A (CsA), methylprednizolone, AZA and antifymphocyte globulin. Forty patients had received a kidney graft from living related donor (LRD).Serum creatinine (Cr), total protein (Pt), SGPT levels, WBC, platelet count and Ht were recorded every two months for a period of one year before and one year after conversion. At the same time period infections were recorded. Proteinuria (12 patients) was recorded at the time of conversion and six months later. Statistical analysis was done with ANOVA for repeated measures and paired t test.Serum Cr was 1.31+0.35 mg/dl, 1.41±0.38 mg/ dl, 1.35±0.38 mg/dl, 1.37±0.35 mg/dl, 1.45±0.38 mg/dl, 1.45±0.38 mg/dl και 1.47±0.40 mg/dl 12, 10, 8, 6, 4, 2 and 0 months before the conversion respectively (p=0.0005), and 1.54±0.41 mg/dl, 1.50±0.41 mg/dl, 1.54v0.47 mg/dl, 1.60±0.49 mg/dl, 1.56±0.44 mg/dl, 1.66+0.57 mg/dl 2, 4, 6, 8, 10 and 12 months after conversion respectively (p=NS). Proteiuria was 0.59v0.64 g/24h before and 0.64±0.69 g/24h one year after conversion (p=NS). The infections per patient year were 0.44±0.54 before and 0.42v0.53 one year after the conversion (p=NS). WBC, platelets and Ht, the serum Pt and SGPT did not show significant difference during time before and after the conversion.In conclusion the shift from AZA to MMF retarded the graft function deterioration in patients with a history of acute rejection episode and/or chronic allograft nephropathy and allowed the lowering of cyclosporine dose in patients with cyclosporine toxicity and grafts from aged donors. This conversion was not accompanied by new acute rejection episodes, new cases of chronic allograft nephropathy and there was no patient or graft loss.