Comparison between mycophenolate mofetil- and azathioprine-based immunosuppressions in clinical lung transplantation

Abstract

Background The aim of the study was to assess the impact of mycophenolate mofetil (MMF) on the early phase after lung transplantation. Patients and methods Thirty-eight consecutive patients between November 1994 and January 1997 were treated with cyclosporine, prednisolone, antithymocyte globuline induction therapy, and either MMF (n = 21) or azathioprine (Aza) (n = 17). Four patients from the MMF group and 2 patients from the Aza group were intubated and in the ICU prior to transplantation. Demographic data and primary diagnosis were comparable. MMF was administered at a dosage of 2 gm/day whereas Aza was initiated at 2 mg/kg/day and adapted by leukocyte count. Three-month survival and incidence of rejections and infections were compared. Results Six-month survival in the MMF group was 76% compared to 65% in the Aza group (n.s.). The mean number of acute rejection episodes in the MMF and Aza group were 0.29 ± 0.10 and 1.53 ± 0.29 ( p < 0.01) respectively. Transbronchial biopsy (TBB) results ≥ grade 2 ISHLT were seen in 10% of MMF and in 43% of Aza-treated patients; completely free from rejection were 17 MMF and 3 Aza patients. The mean number of infections per patient in the MMF and Aza group were 1.57 ± 0.29 and 2.29 ± 0.40 respectively, bacterial (1.10 vs 1.71), viral (0.35 vs 0.33), and fungal (0.14 vs 0.24) infections were the same in both groups. Conclusions These data result suggest that mycophenolate mofetil therapy is more effective in preventing rejection episodes in patients early after lung transplantation than therapy with azathioprine. We therefore conclude that MMF is a safe and effective drug to optimize immunosuppressive therapy in the early phase after lung transplantation.