2010 - TTS International Congress


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Clinical Immunosuppression Kidney early

22.22 - A clinical study comparing Azathioprine and Mycophenolate mofetil after IL2 receptor antibody induction in live related kidney transplantation

Presenter: sandip, bhattacharya, kolkata, India
Authors: bhattacharya s., seal m., sural s.

A CLINICAL STUDY COMPARING AZATHIOPRINE AND MYCOPHENOLATE MOFETIL AFTER IL2 RECEPTOR ANTIBODY INDUCTION IN LIVE RELATED KIDNEY TRANSPLANTATION

CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

S.K. Bhattacharya1, M.C. Seal1, S. Sural2
1Nephrology, REMEDY NURSING HOME, A UNIT OF CALCUTTA UROLOGY RESEARCH CENTER, 700014/INDIA, 2Nephrology, PEERLESS HOSPITAL&B K ROY RESEARCH CENTER, KOLKATA/INDIA

Body: INTRODUCTION- Mycophenolate mofetil (MMF) has almost replaced the Azathioprine (AZA) in most of the newer immunosuppressive protocol. However recently there are some data doubting the superiority of MMF when using IL2 receptor antibody induction and tacrolimus. The significantly lesser cost of AZA is another important factor in favor of its use in the developing countries. The present study was done to compare the efficacy and adverse effects of AZA versus MMF in live related kidney transplantation program using IL2 receptor antibody induction and tacrolimus based protocol. METHODS- Of all the renal allograft recipients who underwent transplant surgery from January 2008 to June 2009 those 127 patients who received IL2 receptor antibody daclizumab induction and tacrolimus with a minimum follow up of six months were included in the present study. At each visit after discharge they were assessed clinically and laboratory investigations including hematological tests, BUN,creatinine, electrolytes were done. Tacrolimus level was done regularly and dose was adjusted according to standard hospital protocol. Graft biopsy was done whenever rejection is suspected. The patients were also screened for infection in each visit. The outcome was evaluated in terms of acute rejection episodes, infections, hematological abnormality including bone marrow suppression, serum creatinine at the end of six months, death and graft loss between the group who received AZA versus the group receiving MMF. Student’s t test and chi square test were performed for statistical analysis and p value< 0.05 was considered as significant. RESULTS –The study group comprised of 127 allograft recipients. Mean age was 43.2 ± 14.2 years and there were 88 males and 39 females. Of 127 recipients 83 were in MMF group and 44 were in AZA group. The incidence of Acute Rejection episodes were similar in those who received MMF (7/83, 8.4%) as compared to those who received AZA (4/44, 9.1%). The mean serum creatinine at the end of 6 months was also similar between the two groups (1.14 ± 0.5 mg/dl in MMF group and 1.12 ± 0.8 mg/dl in AZA group. Leucopenia requiring temporary discontinuation of the drug occurred in 3 (6.8 %) patients in AZA group and 5 (6.0 %) in MMF group. CMV reactivation was more common in MMF group (5/83, 6.1%) compared to AZA group (2/44, 4.5%), though statistically not significant.There was no difference in graft and patient loss between the two groups. In the MMF group the cost of therapy was higher by 100 US Dollars extra per month which is a definite economic burden for most of the recipients in the developing countries. CONCLUSION – AZA is found to be as good as MMF in preventing acute rejection episodes at a much lower cost when used with tacrolimus after IL2 receptor antibody induction. The adverse effect profile is similar with the chance of CMV reactivation is probably less in AZA group. AZA remains an important drug while chosing immunosuppressive therapy in kidney transplant.

Disclosure: All authors have declared no conflicts of interest.


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