Attallah N, Goggins M, Nori U, Abouljoud M, Zasuwa G, Venkat K K, Parasuraman R
Department of Nephrology and Hypertension, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
Transplant Proc. 2005 Jun;37(5):2060-2. doi: 10.1016/j.transproceed.2005.03.009.
The use of mycophenolate mofetil (MMF) in renal transplantation results in a 50% lower incidence of acute rejection compared to azathioprine (AZA). However, the graft survival reports are conflicting: the European trial and US database analysis suggest better survival with MMF, an observation that was not seen in the US and tricontinental studies.
We retrospectively reviewed our single-center experience (60% African-Americans) comparing the serum creatinine (SCr) values and 3-year actual graft survival with MMF versus AZA-based immunosuppression. Group I included patients transplanted between January 1990 and December 1992 on cyclosporine (CSA), AZA, and steroids; group II subjects, from January 1996 to December 1998 on CSA, MMF, and steroids. We analyzed SCr and all causes of graft losses at 3, 6, 12, 18, 24, and 36 months posttransplantation.
The patient demographics were similar in both groups as was the mean SCr values at different times. The time-group interaction for SCr, the Kruskal-Wallis test for SCr for different categories (<1.5, 1.5 to 2.0, 2.0 to 2.5, and >2.5 mg/dL) and the all-cause graft loss between the two groups were not significantly different.
Our results failed to show better long-term actual graft survival despite the 6-year interval between the two groups. These findings agree with the results of the United States and the tricontinental studies. A lower incidence of acute rejection early after transplantation observed with MMF may not always translate into a long-term benefit, possibly due to the influence of nonimmunological factors, such as hypertension, calcineurin inhibitor toxicity, more frequent cytomegalovirus infections, and increased attempts to withdraw steroids using MMF-based protocols.
与硫唑嘌呤（AZA）相比，霉酚酸酯（MMF）用于肾移植时急性排斥反应的发生率降低50%。然而，关于移植物存活的报告存在矛盾：欧洲试验和美国数据库分析表明MMF可带来更好的存活率，但在美国和三大洲研究中未观察到这一现象。
我们回顾性分析了单中心经验（60%为非裔美国人），比较了接受MMF与基于AZA的免疫抑制治疗的患者的血清肌酐（SCr）值及3年实际移植物存活率。第一组包括1990年1月至1992年12月间接受环孢素（CSA）、AZA和类固醇治疗的移植患者；第二组为1996年1月至1998年12月间接受CSA、MMF和类固醇治疗的患者。我们分析了移植后3、6、12、18、24和36个月时的SCr及移植物丢失的所有原因。
两组患者的人口统计学特征相似，不同时间的平均SCr值也相似。两组间SCr的时间-组交互作用、不同类别（<1.5、1.5至2.0、2.0至2.5及>2.5 mg/dL）SCr的Kruskal-Wallis检验以及全因移植物丢失均无显著差异。
尽管两组间隔6年，但我们的结果未能显示出更好的长期实际移植物存活率。这些发现与美国和三大洲研究的结果一致。MMF在移植后早期观察到的急性排斥反应发生率较低，可能并不总是转化为长期益处，这可能是由于非免疫因素的影响，如高血压、钙调神经磷酸酶抑制剂毒性、更频繁的巨细胞病毒感染以及基于MMF方案增加了停用类固醇的尝试。
