Micophenolat Mofetil Versus Azathioprine: Effects on Renal Graft Function in Early Posttransplant Period

Abstract

All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA), Azathioprine (AZA) or Mycophenolate Mofetil (MMF) and Prednisolone. AZA has been used in clinical transplantation for more than  years and was the fi rst immunosuppressive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in  after several clinical trials proved that it was more effi cient than AZA for prevention of acute rejection episodes. Our aim was to evaluate infl uence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited  patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment,  patients received AZA and  MMF. In order to assess renal graft function, following parameters were evaluated: glomerular fi ltration rate GFR (ml/min) creatinine clearance (CrCl) (ml/min),  h urine output (ml/day), and from the serum potassium, sodium, urea and creatinine (mmol/dm). Signifi cantly higher average values of  hour urine output were recorded during fi rst seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically signifi cant decrease, starting with the second postoperative day, in MMF vs. AZA group (,±, vs. ,±,; p<,). GFR was signifi cantly higher in MMF compared to the AZA group of patients. On the fi rst post-transplant day CrCl was higher in AZA group (,± vs. ,±,; p=,), next six days situation is reversed CrCl is signifi cantly higher in the MMF group (,± vs. , ±,  p=,). MMF vs. AZA therapy was associated with protective eff ect against worsening of renal function in fi rst seven post-transplant days.

Protective effect of carvacrol against hepato-renal toxicity induced by azathioprine in rats

“…In a study by El-Ashmawy and Bayad, AZAinduced renal damage and its amelioration by treatment with folic acid and grape seed extract were reported for experimental animal model (21). Also, significant higher serum creatinine, lower glomerular filtration rate, and creatinine clearance have been previously found in human subjects and rats treated with AZA (21,25,26). Our study finding revealed that the nephrotoxicity of AZA could have been due to generation of ROS with consequent adverse effects on the functions of the kidney, which was consistence with the results from previous studies reporting the involvement of oxidative stress and lipid peroxidation in AZA-induced liver toxicity.…”

The Efficacy and Safety of Mizoribine versus Mycophenolate Mofetil for the Treatment of Renal Transplantation: A Systematic Review and Meta-Analysis

“…Antiproliferative immunosuppressants mainly include mizoribine (MZR), azathioprine (AZA), and mycophenolate mofetil (MMF). AZA is rarely used in recipients after renal transplantation because of its severe hepatotoxicity and bone marrow suppression toxicity [7]. MMF is currently recommended as the first-line drug of antiproliferative drugs, but the application of MMF after renal transplantation is easy to cause gastrointestinal reactions such as diarrhea, abdominal pain, leucopenia, infection, and liver function damage.…”