Outcomes of cadaveric renal transplantation in patients using mycophenolate mofetil or azathioprine
Date
2016-10-12
Authors
Gathara, Linda
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Abstract
Introduction: Mycophenolate Mofetil (MMF) has replaced Azathioprine (AZA) in immunosuppressive regimens worldwide in the prevention of acute allograft rejection. Whether long term treatment with MMF is superior to treatment with AZA is a matter of debate. There are no studies in South Africa that have been done to show that MMF is superior to AZA.
Objectives: To describe the outcomes of cadaveric renal transplantation in patients using Mycophenolate Mofetil or Azathioprine over a five year period at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
Design: This was a retrospective comparative study.
Setting: The CMJAH Renal Transplant Unit in Johannesburg, Republic of South Africa.
Patients: A convenience sample of all eligible patients, 208 in total, was recruited from the Renal Transplant Unit at CMJAH.
Methods: The study was approved by the University of the Witwatersrand Human Research Ethics Committee (Medical) (Protocol Number: M130434). The data source was clinical records of renal transplant recipients at the Renal Transplant Unit at CMJAH from 1985-2013, who were treated with one of the two immunosuppressive agents required for analysis in the study. The data were entered in Microsoft Excel Spreadsheets and transferred to STATA version 14 for statistical analysis.
Results: Of the 208 patients, 101 patients were treated with Azathioprine and 107 patients treated with Mycophenolate Mofetil, in addition to corticosteroids and cyclosporine. A total of 16 patients developed acute allograft rejection 12-52 weeks after cadaveric transplantation. Of these, 6% were in the AZA group and 10 % in the MMF group. There was a mortality rate of 1% in the MMF and 16.8% in the AZA group respectively (p= 0.0001). The serum creatinine at 3 months was found to be a strong predictor of allograft function in patients on Mycophenolate Mofetil (p<0.001). After adjusting for the confounders, serum creatinine at 3 months remained a strong predictor of outcome. Patients experiencing abdominal pain while on treatment with Mycophenolate Mofetil were 62% less likely to develop acute allograft rejection than patients on treatment with Azathioprine [unadjusted HR = 0.38(0.14-1.05)]. This finding however, is not statistically significant (p=0.06). After adjusting for the other confounders the association with abdominal pain was marginally significant (adjusted HR 0.18(0.01-1.02) p=0.05).
Conclusions: Patient survival was superior in the longterm in cadaveric renal transplant patients receiving Mycophenolate Mofetil therapy.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of
Master of Medicine in Internal Medicine
Johannesburg 2016
Keywords
Cadaveric Renal Transplantation