Mycophenolate mofetil (MMF) versus azathioprine (AZA) in pancreas transplantation: a single-center experience

Aim: Advances in immunosuppression and careful monitoring for rejection are largely responsible for improved results in pancreas transplantation. We c onducted a retrospective study to establish the effectiveness of immunosupp ressive therapy with mycophenolate mofetil (MMF) instead of azatioprine (AZ A) in pancreas transplantation and to assess adverse effects in the two dif ferent immunosuppressive regimes. Subjects and methods, Since 1991,27 pancr eas transplantations were performed in 25 patients at our Institute. For in duction therapy, immunosuppressant protocol consisted of quadruple immunosu ppressive therapy with cyclosporine, steroids, antilymphocyte globulin and AZA in 13 patients or MMF in 12 patients respectively. Results: Acute rejec tion occurred in 76% of patients in the AZA group compared with 53% in the MMF group. Steroid-resistant rejection was observed in 7% in the MMF group compared to 38% of patients on AZA (p < 0.01). Two kidney grafts were lost due to acute rejection in the AZA group, one pancreas was lost due to acute rejection and one to chronic rejection in the MMF group. There were no sig nificant differences in CMV infection. Severe fungal infections were noted in 2 patients treated with MMF. Malignancy occurred in 1 patient (pancreas graft lymphoma) in MMF. Conclusions: In conclusion, patients treated with M MF required less frequent and less intensive treatment for acute rejection. However, its short- and long-term side effects should be further investiga ted.