THE IMPACT OF MYCOPHENOLATE MOFETIL (MMF) ON CYTOMEGALOVIRUS (CMV) DISEASE.

Abstract

597 While our group has recently shown that MMF does not increase the overall incidence of CMV infection in kidney transplant recipients, its role in CMV disease remains to be addressed. Adult kidney transplant recipients who developed CMV disease between January/1994 and June/1996, were classified according to the use of Azathioprine (AZA) or MMF, in addition to the universal use of cyclosporin A and steroids. Severity scores of CMV disease were compared using Chi-square, interval time to developing CMV disease was analyzed with Kaplan-Meier and compared with log-rank test, and categorical data was analyzed using Fisher's Exact Test. Seventeen patients on the AZA group and 12 on the MMF group developed CMV disease. Between the AZA and MMF groups there were no differences in age(mean±SD age: 43±15.4 and 41±13 years); gender (ratio male:female 9:8 and 8:4); CMV D+/R- (8/17, and 6/12), and etiology of the renal disease, respectively. Patients on AZA had more episodes of rejection(13/17 vs. 6/12) and were given OKT3 more frequently (10/17 vs. 3/12). However, patients in the MMF group had a higher frequency of organ involvement(7/12 vs. 3/17) (p=0.03), a higher severity score (5.5 vs. 4.0) (p=0.07) and a higher number of organs involved with CMV (p=0.015). In addition, there was a trend towards an earlier development of CMV disease in the MMF group(p=0.09). Conclusions from this study indicate that while MMF does not increase the overall incidence of CMV infection in renal transplant recipients, it appears to influence the rate and severity of CMV disease.