Mycophenolic acid versus azathioprine as primary immunosuppression for kidney transplant recipients

Wagner, Martin; Earley, Amy; Webster, Angela C; Schmid, Christopher H.; Balk, Ethan M; Uhlig, Katrin

doi:10.1002/14651858.cd007746.pub2

Cited by 74 publications

(71 citation statements)

References 135 publications

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“…3-5 Mycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), and it reduces the incidence of acute rejection and benefits graft survival. 6 From previous studies, it is well known that exposure to MPA in early pregnancy of female transplant recipients has been associated with increased rate of miscarriages and birth defects in the live born. 7,8 Accordingly, common practice in female patients who wish to become pregnant is either to withdraw MPA or switch to azathioprine before conception.…”

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confidence: 99%

Exposure to Mycophenolate and Fatherhood

et al. 2017

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BackgroundMycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil and mycophenolate sodium, and it is widely used after organ transplantation. In women, taking MPA is teratogenic and may also influence spermatogenesis. There is a lack of knowledge regarding outcome of pregnancies fathered by men exposed to MPA.MethodsWe compared outcomes in pregnancies fathered by renal transplant men per whether they had been exposed to MPA or not at time of conception. A nationwide population-based retrospective cohort study was performed. Data from the Norwegian Renal Registry with all renal transplanted men alive between January 1, 1995 and December 31, 2015 were included, and relevant outcome data were extracted from the Medical Birth Registry of Norway.ResultsDuring the given time, 230 immunosuppressed renal transplanted men fathered 350 children (155 on MPA/195 not on MPA). There were no significant increased risks of malformation (3.9% vs. 2.6%, P = 0.49) in MPA exposed versus unexposed cohorts of children. The average dose (±SD) of mycophenolate was 1.42 ± 0.3 g/day and the individual median MPA trough concentration in the time period of anticipated conception and pregnancy was 2.8 ± 1.6 mg/L. Birth weight was similar in exposed and unexposed cohorts of children; 3381 ± 681 g vs. 3429 ± 714 g (P = 0.53).ConclusionsPaternal exposure to MPA did not increase the risk of adverse birth outcomes in children fathered by male kidney transplanted patients. These results are reassuring and support the continuation of paternal MPA treatment before, during, and after conception.

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confidence: 99%

Exposure to Mycophenolate and Fatherhood

et al. 2017

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“…This digestive manifestation of the CMV infection was shown to be more common in patients treated with cyclosporine A (CsA) [8,9]. If we assess the five or six, commonly used, immunosuppressive medications, we observe that mycophenolate mofetil (MMF) is associated with a higher rate of CMV tissue invasiveness especially in the GI tract [6][7][8]10]. Indeed, increased immunosuppression, such as by anti-lymphocyte antibody and conventional MMF therapy is one of the main predisposing factors to CMV infection.…”

Section: Cytomegalovirus (Cmv) Infectionmentioning

confidence: 99%

“…There are several studies that discuss the connection of tissue invasiveness of CMV, more or less targeted on the GI tract, in comparison with the treatment with MMF [10][11][12]. Mycophenolate mofetil treatment and CMV invasiveness were also compared with the equivalent of the classic MMF, i.e.…”

Section: Cytomegalovirus (Cmv) Infectionmentioning

confidence: 99%

“…Often, the GI consequences of CMV infection, such as persistent and abundant diarrhea, nausea, vomiting and leukopenia [14] have led to the cessation of the MMF treatment or to the reintroduction of Aza, replacing the MMF [10]. All these digestive and general symptoms are more pronounced if MMF is administered in a crisis situation of acute rejection, when high doses of other immunosuppressant drugs, including steroids, are concomitantly used.…”

Section: Cytomegalovirus (Cmv) Infectionmentioning

confidence: 99%

“…Obviously, as a consequence of the mentioned symptoms, other strategic attitudes have been selected in order to alter the manner of administration of these immunosuppressant drugs (total dose reduction, or dividing the total dose into two or three smaller doses which resulted in the reduction of the intensity and duration of the side-effects) [10,11,21]. …”

Section: Diarrheamentioning

confidence: 99%

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Gastrointestinal Side Effects of Post-Transplant Therapy

Lucan

Berardinelli

2016

JGLD

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Modern immunosuppressive therapy has produced a real revolution in renal and organ transplantation but it comes with the price of multiple side effects. There are many gastrointestinal (GI) complications that are the consequence of transplant immunosuppressant medication. In fact, for any immunosuppressant therapy, certain standardized precepts and attitudes that aim to reduce the incidence and the impact of the medication side effects must be applied. Many patients undergo renal transplantation and the physicians have to be aware of the advantages and the risks associated. This article reviews the main GI complications that may arise as a consequence of immunosuppressive therapy after solid organ transplantation, focusing on renal and renal/pancreas transplantation, as well as the ways in which the incidence of these complications can be reduced. Management of the post-transplant therapy is mandatory in order to increase not only the grafts’ and the patients’ survival, but also their quality of life by the occurrence of fewer complications. Abbreviations: Aza: azathioprine; CMV: cytomegalovirus; CsA: cyclosporine A; GI: gastrointestinal; MMF: mycophenolate mofetil; NSAID: non-steroidal anti-inflammatory drugs; Tac: tacrolimus.

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How does mycophenolic acid compare with azathioprine for primary immunosuppression after kidney transplant?

Burch¹,

Hodson²

2016

Cochrane Clinical Answers

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Mycophenolic acid versus azathioprine as primary immunosuppression for kidney transplant recipients

Cited by 74 publications

References 135 publications

Exposure to Mycophenolate and Fatherhood

Exposure to Mycophenolate and Fatherhood

Gastrointestinal Side Effects of Post-Transplant Therapy

How does mycophenolic acid compare with azathioprine for primary immunosuppression after kidney transplant?

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