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40 Does Mycophenolate Mofetil Increase the Incidence of Cytomegalovirus Disease Compared To Azathioprine After Cadaveric Kidney Transplantation?
Author(s) -
BubićFilipi L,
BašićJukić N,
Puretić Z,
Barišić I,
Šmalcelj R,
Pasini J,
Kes P
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_40_40.x
Subject(s) - medicine , azathioprine , gastroenterology , incidence (geometry) , mycophenolate , transplantation , cytomegalovirus , kidney transplantation , surgery , immunology , disease , herpesviridae , viral disease , virus , physics , optics
Although most published papers had not found an increase in the incidence of cytomegalovirus (CMV) disease with the use of mycophenolate mophetil (MMF) in kidney transplant patients, we had the feeling from our everyday practice that after its introduction, the number of patients with the CMV disease increased. In order to test this hypothesis, we performed retrospective analysis of our database, comparing the incidence of CMV disease in patients treated with azathioprine (AZA) and patients treated with MMF. Cytomegalovirus disease was defined as CMV antigenemia (positive CMV pp65 determined by ELISA test) plus any of following: decreased leucocytes or thrombocytes, increased transaminases, or an increase in serum creatinine. The azathioprine treatred group (AZA group) included 280 patients (132 female) treated for a total of 17,672 months with AZA + Cyclosporine A (CyA) + steroid, or AZA + steroid, while the MMF group included 219 patients (112 female) treated for a total 5079 months with MMF + CyA + steroid, or MMF + steroid. There was no difference in acute rejection episodes between the AZA and the MMF groups. The AZA group had 51 CMV disease episodes (1 episode per 346.5 treatment months), and the MMF group experienced 43 epizodes (1 per 118.1 months) ( P < 0.01). Mean onset of the CMV disease was 32.65 ± 47.69 months (SD) after transplantation in the AZA group, and 3.72 ± 4.43 in the MMF group. There was no difference between two treatment groups regarding the donor–recipient CMV status mismatch. Despite having the increased incidence of CMV disease, the MMF group had less severe disease compared to the AZA group with decrease in leucocyte count in 11.6% vs 15.7% of episodes, decrease in thrombocyte count in 20.9% vs 21.6%, elevation of transaminases in 18.6% vs 29.4% respectively, and finally increase in serum creatinine greater than 20% in 51.2% in the MMF vs 74.5% in the AZA group. Five patients from the AZA group experienced CMV pneumonitis with the mortality rate of 80%. Only one patient from the MMF group had CMV pneumonitis, and he survived. According to our results, patients treated with MMF have an increased risk for development of the CMV disease. However, the disease course is less severe, and less frequently accompanied with the decrease in renal function in comparison to the AZA group.