AZATHIOPRINE VS. MYCOPHENOLATE MOFETIL IN GERIATRIC RENAL TRANSPLANT RECIPIENTS

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907 It has been well demonstrated that a regimen of Mycophenolate Mofetil (MMF), Cyclosporine (CsA) and Prednisone (Pred) reduces the incidence of acute rejection in renal transplant recipients, as compared to previous regimens based on Azathioprine (AZA), CsA and Pred. In the general renal transplant patient (pt) population, immunosuppressive regimens including MMF are usually well tolerated. It is not clear if this holds true for older transplant recipients, who may be more susceptible to complications from the greater immunosuppression conferred by MMF. We retrospectively analyzed our geriatric renal transplant population (age >60 years, 1990-97), and compared a cohort of 46 pt's treated with AZA, Pred and CsA to a cohort of 45 pt's treated with MMF, Pred and CsA who had at least 12 month of follow up. (Table)TableThere were no significant differences between the groups with regard to age, gender, race, incidence of diabetes, HLA match, donor source, and induction therapy. Pt and graft survival during the first year were not significantly different even though 7 death occurred in the MMF group and only 4 in the AZA group. During the first year of follow up we observed 17 infections requiring hospitalization in 11 pt's in the MMF treated group as compared to 7 in 5 pt's in the AZA group. A logistic regression model accounting for the above mentioned covariates isolated MMF vs. AZA as the only significant risk factor for the occurrence of serious infectious events (all: p<0.01; opportunistic: p<0.01). Conclusion: An immunosuppressive regimen of MMF, CsA and Pred appears to be correlated with an increased incidence of infectious adverse events as compared to AZA, CsA and Pred in elderly patients. Cautious use of MMF might be indicated in elderly renal transplant recipients.