Shah Sapna, Collett Dave, Johnson Rachel, Thuraisingham Raj C, Raftery Martin J, Rudge Chris J, Yaqoob Muhammad M
Department for Experimental Medicine, Nephrology, and Critical Care, William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom.
Transplantation. 2006 Dec 27;82(12):1634-9. doi: 10.1097/01.tp.0000250713.65004.35.
Randomized controlled trials and U.S. Registry data have demonstrated that mycophenolate mofetil (MMF) reduces acute rejection rates and improves graft survival. We undertook the first paired kidney analysis comparing the effects of MMF and azathioprine on graft outcome in the United Kingdom.
In all, 238 deceased donors from 1999 to 2002 who donated one kidney to a patient treated with MMF and the other kidney to a patient treated with azathioprine were identified from the national transplant database held by U.K. Transplant. Graft function and rates of change of graft function were compared using multiple linear regression analyses adjusting for covariates on an intention-to-treat basis. Incidence of acute rejection and delayed graft function were studied using logistic regression. Patient and graft survival censored for death were evaluated with Cox regression analyses.
The MMF-treated patients exhibited a nonsignificant trend towards improved graft function but with increased rejection rates (44% versus 31%, P < 0.01). Treatment with MMF did not reduce delayed graft function rates. Univariate analysis showed that graft survival was inferior in MMF-treated patients (90% versus 95%, log-rank, P = 0.02) but in multivariate Cox regression models, MMF treatment was not a significant factor. Surprisingly, in the first year 32% of patients achieved daily doses of less than 2 g of MMF compared to 18% of patients who received less than 100 mg of azathioprine (P < 0.01).
In this real-life study, there was no difference in patient or graft outcome between MMF and azathioprine treated groups despite increased rejection rates in patients receiving MMF therapy.
随机对照试验和美国登记数据表明，霉酚酸酯（MMF）可降低急性排斥反应率并改善移植物存活率。我们在英国进行了首次配对肾脏分析，比较MMF和硫唑嘌呤对移植物结局的影响。
从英国移植协会持有的国家移植数据库中，识别出1999年至2002年期间的238名已故供体，他们分别将一个肾脏捐献给接受MMF治疗的患者，另一个肾脏捐献给接受硫唑嘌呤治疗的患者。使用多线性回归分析比较移植物功能及移植物功能变化率，并在意向性治疗基础上对协变量进行校正。采用逻辑回归研究急性排斥反应和移植肾功能延迟的发生率。通过Cox回归分析评估因死亡而截尾的患者和移植物存活率。
接受MMF治疗的患者移植物功能有改善趋势，但差异无统计学意义，不过排斥反应率有所增加（44%对31%，P<0.01）。MMF治疗并未降低移植肾功能延迟发生率。单因素分析显示，接受MMF治疗的患者移植物存活率较低（90%对95%，对数秩检验，P = 0.02），但在多变量Cox回归模型中，MMF治疗并非显著因素。令人惊讶的是，第一年32%接受MMF治疗的患者每日剂量低于2 g，而接受硫唑嘌呤治疗且剂量低于100 mg的患者比例为18%（P<0.01）。
在这项实际研究中，尽管接受MMF治疗的患者排斥反应率增加，但MMF治疗组和硫唑嘌呤治疗组在患者或移植物结局方面并无差异。
