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

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 19 94 and January 1997 were treated with cyclosporine, prednisolone, antithymo cyte 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 dosag e of 2 gm/day whereas Aza was initiated at 2 mg/kg/day and adapted by leuko cyte 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 a nd Aza group were 0.29 +/- 0.10 and 1.53 +/- 0.29 (p < 0.01) respectively. Transbronchial biopsy (TBB) results greater than or equal to 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 infectio ns per patient in the MMF and Aza group were 1.57 +/- 0.29 and 2.29 +/- 0.4 0 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 i s more effective in preventing rejection episodes in patients early after l ung transplantation than therapy with azathioprine. We therefore conclude t hat MMF is a safe and effective drug to optimize immunosuppressive therapy in the early phase after lung transplantation. J Heart Lung Transplant 1999 ;18:432-440.