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A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation.

Publication ,  Journal Article
Odorico, JS; Pirsch, JD; Knechtle, SJ; D'Alessandro, AM; Sollinger, HW
Published in: Transplantation
December 27, 1998

BACKGROUND: Mycophenolate mofetil (MMF; Cell-Cept) is a potent and selective inhibitor of B and T lymphocyte proliferation that has proven effective in reducing the incidence of acute rejection in cadaveric kidney transplant recipients in several randomized, blinded clinical studies. Because the frequency and characteristics of rejection episodes may be different and more severe after combined pancreas-kidney transplantation, we hypothesized that MMF would have a significant impact on pancreas-kidney rejection and graft outcome. Therefore, we compared the efficacy of MMF versus azathioprine (AZA) in cyclosporine-treated simultaneous pancreas-kidney transplantations. METHODS: A retrospective comparison of 358 consecutive primary SPK transplantations performed from 1990 to 1997 was conducted. Patients received either MMF (n=109, 3 g/day) or AZA (n=249, 2 mg/kg q.d.) in combination with cyclosporine-based immunosuppression. All patients received a quadruple-drug sequential induction protocol with either OKT3 or Atgam. Several outcome parameters, including patient and graft survival rates and frequency of rejection, were analyzed. RESULTS: MMF-treated patients demonstrated a markedly reduced rate of biopsy-proven kidney rejection (31 vs. 75% AZA, P=0.0001), clinically significant pancreas rejection (7 vs. 24% AZA; P=0.003), and steroid-refractory rejection (15 vs. 52% AZA; P=0.01). As a result, kidney and pancreas allograft survival was significantly better in MMF patients compared with AZA patients (2-year survival rates: kidney, 95 vs. 86%; and pancreas, 95 vs. 83%). Although surgical infections after transplantation were more frequent in MMF patients, MMF patients were more likely to have undergone enteric drainage. Importantly, we did not observe an increased incidence of any of the bacterial, fungal, or viral infections that typically plague immunosuppressed transplant recipients. CONCLUSIONS: This retrospective study demonstrates that MMF is a highly effective immunosuppressant in SPK transplantation. It is not associated with an increased risk of opportunistic infections when a balanced immunosuppressive management approach is used. MMF strikingly reduces the frequency of acute cellular and steroid-resistant rejection. As a result of this combined experience, it is not unexpected then that we observe significantly improved graft survival rates in MMF-treated SPK patients compared with patients receiving a more traditional immunosuppressive regimen.

Duke Scholars

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

December 27, 1998

Volume

66

Issue

12

Start / End Page

1751 / 1759

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Surgery
  • Retrospective Studies
  • Pancreas Transplantation
  • Opportunistic Infections
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Immunosuppressive Agents
 

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Odorico, J. S., Pirsch, J. D., Knechtle, S. J., D’Alessandro, A. M., & Sollinger, H. W. (1998). A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation. Transplantation, 66(12), 1751–1759. https://doi.org/10.1097/00007890-199812270-00032
Odorico, J. S., J. D. Pirsch, S. J. Knechtle, A. M. D’Alessandro, and H. W. Sollinger. “A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation.Transplantation 66, no. 12 (December 27, 1998): 1751–59. https://doi.org/10.1097/00007890-199812270-00032.
Odorico JS, Pirsch JD, Knechtle SJ, D’Alessandro AM, Sollinger HW. A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation. Transplantation. 1998 Dec 27;66(12):1751–9.
Odorico, J. S., et al. “A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation.Transplantation, vol. 66, no. 12, Dec. 1998, pp. 1751–59. Pubmed, doi:10.1097/00007890-199812270-00032.
Odorico JS, Pirsch JD, Knechtle SJ, D’Alessandro AM, Sollinger HW. A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation. Transplantation. 1998 Dec 27;66(12):1751–1759.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

December 27, 1998

Volume

66

Issue

12

Start / End Page

1751 / 1759

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Surgery
  • Retrospective Studies
  • Pancreas Transplantation
  • Opportunistic Infections
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Immunosuppressive Agents