Immunosuppression—Clinical and Animal StudiesComparison between mycophenolate mofetil- and azathioprine-based immunosuppressions in clinical lung transplantation
Section snippets
Patient population
Thirty-eight consecutive patients were entered into this study from November 1994 to January 1997. Twenty-one recipients (12 single lung transplants [SLTX] and 9 bilateral lung transplants [BLTX]) received MMF, and 17 recipients (6 SLTX, 11 BLTX) received Aza. Recipients receiving MMF or Aza were similar in age, gender, pre-operative New York Heart Association functional class, and underlying disease (Table I). Nineteen percent of patients in the MMF group and 12% from the Aza group were
Patient survival
After 6 months, survival was similar between both groups (76% in the MMF group and 65% in the Aza group). There were no intra-operative deaths in either group. One patient of the MMF group was pre-operatively intubated and in the ICU. Though neurologic examination prior transplantation seemed normal, he was detected to have massive brain-stem damage after an uneventful transplantation. He died 3 weeks after transplantation due to generalized sepsis.
All 4 late deaths (after 30 days) in the Aza
Discussion
This single-center pilot study assessed the efficacy of MMF in preventing early acute rejection in recipients of lung allografts. Patients treated with MMF had a low incidence of rejections without increase of infections and a low rate of side effects.
The main limitation of the study is the lack of a true control group, yet all MMF-treated patients were included prospectively and comparisons were made to a historical control group of patients, who were transplanted within 1 year before this
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A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team
2017, PM and RCitation Excerpt :Mycophenolate mofetil has potential side effects of gastrointestinal symptoms (nausea, diarrhea, abdominal cramping), and bone marrow suppression with resulting cytopenias [60]. Azathioprine can cause gastrointestinal toxicity (manifesting with symptoms of nausea, vomiting, diarrhea, fever, malaise, myalgia, and liver enzyme abnormalities), as well as hepatotoxicity and blood dyscrasias (anemia and thrombocytopenia) [61]. These nucleotide-blocking agents also have been associated with new or reactivated infections with JC virus, resulting in progressive multifocal leukoencephalopathy (PML) [60,61].
Mycophenolate monitoring in liver, thoracic, pancreas, and small bowel transplantation: A consensus report
2011, Transplantation ReviewsCitation Excerpt :Mycophenolate mofetil also reduced the incidence of acute rejection (45.0% vs 52.9%, P = .055) and treatment interventions but was associated with a higher incidence of opportunistic infections, mostly herpes simplex (53.3% vs 43.6%, P = .025) [11]. In lung transplant recipients on a CsA-based regimen after antithymocyte globulin induction, MMF was associated with fewer rejection episodes than azathioprine (0.29 ± 0.10 vs 1.53 ± 0.29, respectively; P < .01) [12]. Effective immunosuppression was achieved using TRL and MPA in 30 adult de novo liver graft recipients without prophylactic steroids and led to a graft survival of 83.9% at 2 years [13].
Mycophenolate mofetil reduces alveolar inflammation, acute rejection and graft loss due to bronchiolitis obliterans syndrome after lung transplantation
2010, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :The present study shows a clear reduction in the incidence, the recurrence and the severity of AR in MMF-based immunosuppression. This is in-line with three single-center studies including a total of 45 patients [13–15]. In contrast, two other randomized studies found no benefit of MMF over AZA [18,19].
Tacrolimus and Azathioprine Versus Cyclosporine and Mycophenolate Mofetil After Lung Transplantation: A Retrospective Cohort Study
2009, Journal of Heart and Lung TransplantationCitation Excerpt :The cyclosporine group had a greater number of viral infections only. Regarding the comparative efficacy of MMF and azathioprine, early non-randomized studies16,17 using cyclosporine and anti-thymocyte globulin as maintenance immunosuppression suggested that MMF therapy may be associated with a lower incidence of biopsy-proven AR in the first year after transplantation. Subsequently, results of 2 randomized prospective trials, one in the United States and one in Europe, have been published18,19 in which cyclosporine was again the main calcineurin inhibitor.
Lung transplantation for cystic fibrosis: Current concepts and one center's experience
2007, Journal of Cystic Fibrosis