CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

S. Jain¹, V. Kher², S. Pokhariyal², V. Saxena², S.B. Bansal², S. Gulati³, M. Singhal^4
1Nephrology And Transplant Medicine, Medanta Medicity, Gurgaon/INDIA, ²Nephrology, MEDANTA MEDICITY, GURGAON/INDIA, ³Nephrology, FORTIS INSTITUTE OF RENAL SCIENCES AND TRANSPLANTATION, VASANT KUNJ, NEW DELHI/INDIA, ⁴Nephrology, Fortis Hospital, NOIDA/INDIA

Body: Introduction:There is conflicting data regarding the comparative efficacy of MMF versus Azathioprine as maintenance immunosuppression in live related kidney transplantation. Cost remains an importantguiding factor in deciding immunosuppressive protocols in our country.
Aim: This study was conducted to compare the efficacy of Azathioprine versus MMF as maintenance immunosuppression in live related transplant programme

Patients & Methods: We have done 266 live donor kidney transplants from May 2006 to April 2009. For the purpose of this study we excluded patients on cyclosporine based regimen and steroid freeprotocol. The study group comprises of 213 consecutive patients who were on tacrolimus based protocol and had minimum of three months of follow up. Of these, 110 (51.6%) received Interleukin 2receptor antibody (IL2RA) & 103 (48.4%) did not. The choice of IL-2RA and maintenance immunosuppression (MMF vs Aza) was as per patient counselling and preference. Patients were monitoredclinically & with biochemical tests at each visit. Tacrolimus levels were done routinely & graft biopsy was done whenever rejection was suspected. Levels of Tacrolimus were targeted at8-12ng/ml for first three months, 6-8 ng/ml for next 3-6 months and 4-6 ng/ml thereafter .The outcome was evaluated in terms of acute rejection episodes, infections, PTDM, death & graft lossbetween the groups. Fisher exact test’ and ‘Chi Square’ were used for statistical analysis and a P value <0.05 was considered significant.

Results: The study group comprised of 213 patients (169 males (79.3%) & 44 (20.7%) females. The mean age of patients was 41 +12.6 years and the mean duration of follow up was 17 + 9.5 months. Ofthe 213 patients, 99 were in MMF group (40 with IL2RA induction and 59 without induction) and 114 were in the Azathioprine group (70 with IL2RA induction and 34 without induction). Of the 213patients, 34 (15.9 %) who developed acute rejection, the incidence of acute rejection was similar in patients who received MMF (13/99, 13.1%) as compared to those with Azathioprine(21/114,18.4%),(p=0.39). There was no difference in the incidence of AR in subgroup of patients who received IL2R as compared to those who did not receive induction in the 2 groups ( 5/40 vs 8 / 59in <MMF gp and 10/70 vs 11/44 in Aza gp, p=0.39)Infections were observed in 44/213 (20.6%) patients. 3 patients developed CMV disease and 2 of them were in the MMF group The incidence ofinfections was similar in the 2 groups (19/99,19.1% vs 25/114,21.9%, p=0.75) . Graft loss occurred in 7/213 (3.3%) and death in 8/213 (3.75%) patients. 6 of the 8 patients who died had functioninggraft. The rate of graft loss was (3/99 vs 4/114, p=0.85) and death ( 5/99 vs 3 /114, p=0.47) was similar. The overall patient survival was 96.4%. and death censored graft survival was 95.8% .

Conclusion: We conclude that in Tacrolimus based immunosuppression Azathioprine is as good as MMF as maintenance immunosuppressive drug in kidney transplantation. It is also more costeffective.

Disclosure: All authors have declared no conflicts of interest.