Outcomes of Cadaveric Renal Transplantation Using Mycophenolate Mofetil or Azathioprine in South Africa

Abstract

Introduction: Mycophenolate mofetil (MMF) has, to a great extent, replaced azathioprine (AZA) in immunosuppressive regimens worldwide in the prevention of acute allograft rejection. However, there are no studies in South Africa to show that MMF is superior to AZA. Objectives: To describe the outcomes of cadaveric renal transplantation in patients treated with either MMF or AZA and followed up over a 5-year period. Design: This was a retrospective comparative study. Methods: A convenience sample of all eligible patients, 208 in total, was recruited from the Renal Transplant Unit at the Charlotte Maxeke Johannesburg Academic Hospital from 1985 to 2013, who were treated with either MMF or AZA. Results: Of the 208 patients, 101 patients were treated with AZA and 107 patients treated with MMF, in addition to corticosteroids and cyclosporine. A total of 16 patients developed acute allograft rejection 12-52 weeks after cadaveric transplantation. Of these, 6% were in the AZA group and 10% in the MMF group. There was a 1% mortality in the MMF group and 16.8% in the AZA group (p < 0.001). The serum creatinine at a 3-month follow-up was found to be a strong predictor of allograft function in patients on MMF (p < 0.001). Conclusion: Patient survival was superior in the long term in cadaveric renal transplant patients receiving MMF therapy.