Infections in Renal Transplant Recipients Receiving Mycophenolate Versus Azathioprine-Based Immunosuppression
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- Bernabeu-Wittel, M., Naranjo, M., Cisneros, J. et al. Eur J Clin Microbiol Infect Dis (2002) 21: 173. doi:10.1007/s10096-001-0684-y
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Differences in the incidence, etiology, type, and outcome of infections occurring during the first 6 months after transplantation were evaluated in two consecutive cohorts of kidney recipients who received immunosuppressive regimens based on either azathioprine (plus antilymphocyte globulin, cyclosporine A, and prednisone) (ATG-AZA cohort) or mycophenolate-mofetil (plus cyclosporine A and prednisone) (MMF cohort). The overall incidence of infections in the two cohorts was similar (0.99±1.06 infections/patient in the MMF cohort and 1.04±0.99 in the ATG-AZA cohort, P=0.3), as was the incidence of bacterial and fungal infections. In patients who received mycophenolate, cytomegalovirus disease occurred at a higher incidence (0.3±0.54 vs. 0.1±0.34 episodes/patient, P=0.005) and affected the upper gastrointestinal tract more frequently (0.21±0.48 vs. 0.025±0.16 episodes of cytomegalovirus ulcerative esophagitis, gastritis, or duodenitis per patient; P=0.001). A nonsignificant trend toward a higher recipient survival for patients receiving mycophenolate was noted (100% vs. 95%, P=0.07). In multivariate analysis, the following factors were independently associated with a higher risk of cytomegalovirus disease: the serostatus R–/D+ (seronegative recipients who received a kidney from a seropositive donor) (RR=35.7 [95%CI, 7.4–166.7]), treatment with mycophenolate (RR=10.4 [95%CI, 2.7–38.4]), and the development of any episodes of acute rejection (RR=10.1 [95%CI, 2.5–41.6]). These data show that kidney recipients receiving mycophenolate have a higher incidence of cytomegalovirus disease, mainly affecting the upper gastrointestinal tract, compared to those receiving azathioprine-based immunosuppression.