Comparison of Azathioprine vs Mycophenalate Based Induction Free Protocol and One Year Renal Allograft Survival: Retrospective Single Center Study.

Abstract

Aim: To retrospectively evaluate the one year graft survival in our renal transplant recipients on induction free immunosuppression protocol, between Azathioprine vs Mycophenalate Mofetil based regimen. Materials and Methods: Renal transplant patients from April 2000 to November 2012 were retrospectively evaluated. The demographic characteristics, the nature of transplant, donor relationship, degree of matching, immunosuppression protocol, were analyzed. All patients received induction free immunosuppression with Cyclosporine and Prednisolone with either Azathioprine (protocol I) or Mycophenolate Mofetil (protocol II). Patients who did not complete one year followup and those who received induction were excluded. Data was analyzed using SPSS 17. Results: 213 (174 males, 39 females) were included in the study. The mean age at transplant was 37.5 ± 11 years.The common reasons for chronic kidney diseases was 30 (14%) diabetes, 32 (15%) hypertension,89 (41.7%) chronic glomerular disease and 39 (18.3%) chronic interstitial nephritis. 201 (94.3%) were live related, and 12 (5.6%) were cadaver donors. Mother 44 (21.8%), sister 45 (22.3%), wife 37 (18.4%) and brother 17 (8.4%) were the common donors. Donor HLA Class I matching profiles showed 14 (9.7%) four antigen match, 7 (4.8%) triple antigen match, 97 (67.8%) haplomatch, 25 (17.4%) single antigen and 70 (48.9%) mismatches. 201 (94.3 %) patients graft survived at the end of one year. Protocol I was followed in 138 (64.7%) and protocol II in 75 (35.2%) recipients. Multivariate analysis of the data showed no significant difference in age, matching profile, basic disease among the two protocols. The protocol I had 133 (96.3%) functioning graft and 5 (3.6%) graft losses at the year end. Protocol II showed functioning graft in 68 (90.6%) and graft loss in 7 (9.4%) patients. There was no statistically significant difference in one year graft survival among two protocols (p= 0.804,NS). Conclusions: Our experience in Induction Free Immunosuppression regimen had shown good one year graft survival (94.3%), compared to any induction based protocols. We did not find any statistical difference among Azathioprine vs Mycophenolate Mofetil based protocols. This is very useful as Azathioprine based protocols are cost effective with comparable graft outcomes in Indian scenario, where majority of the patients pay for their treatment.