Azathioprine as good as Mycophenolate mofetil for immunosuppression after kidney transplant: Study

The findings of the study are as follows:

· The donor/recipient mismatches and follow-up low dose cyclosporine blood levels were similar between group donor and recipient characteristics.

· Approximately same percentage of biopsied patients treated by either Azathioprine (35.2%) or Mycophenolate mofetil (33.3%) developed chronic allograft nephropathy (hazard ratio (HR) [95% confidence interval (CI)]: 1.147 (0.691 to 1.904, p = 0.595).

· 20 and 21 patients on Mycophenolate mofetil as compared to 34 and 14 on Azathioprine showed either clinical or biopsy-proven subclinical acute cellular rejection, respectively.

· There were no significant differences in combined events of patient and graft survival, delayed graft function (DGF), 3-year glomerular filtration rate, and any adverse events in both groups.

The authors concluded that in the donor kidney transplant recipients who died and were on low-dose cyclosporine and no steroids, Mycophenolate mofetil showed no superior benefit as compared to Azathioprine. Thus, as Azathioprine is cheaper than Mycophenolate mofetil, Azathioprine can be safely used as an alternative to Mycophenolate mofetil, in combination with minimized immunosuppression.

Reference:

Mycophenolate mofetil versus azathioprine in kidney transplant recipients on steroid-free, low-dose cyclosporine immunosuppression (ATHENA): A pragmatic randomized trial by Ruggenenti P et. al published in the Plos One journal.

https://doi.org/10.1371/journal.pmed.1003668