Infections in renal transplant recipients receiving mycophenolate versus azathioprine-based immunosuppression

Eur J Clin Microbiol Infect Dis. 2002 Mar;21(3):173-80. doi: 10.1007/s10096-001-0684-y. Epub 2002 Mar 19.


Differences in the incidence, etiology, type, and outcome of infections occurring during the first 6 months after transplantation were evaluated in two consecutive cohorts of kidney recipients who received immunosuppressive regimens based on either azathioprine (plus antilymphocyte globulin, cyclosporine A, and prednisone) (ATG-AZA cohort) or mycophenolate-mofetil (plus cyclosporine A and prednisone) (MMF cohort). The overall incidence of infections in the two cohorts was similar (0.99+/-1.06 infections/patient in the MMF cohort and 1.04+/-0.99 in the ATG-AZA cohort, P=0.3), as was the incidence of bacterial and fungal infections. In patients who received mycophenolate, cytomegalovirus disease occurred at a higher incidence (0.3+/-0.54 vs. 0.1+/-0.34 episodes/patient, P=0.005) and affected the upper gastrointestinal tract more frequently (0.21+/-0.48 vs. 0.025+/-0.16 episodes of cytomegalovirus ulcerative esophagitis, gastritis, or duodenitis per patient; P=0.001). A nonsignificant trend toward a higher recipient survival for patients receiving mycophenolate was noted (100% vs. 95%, P=0.07). In multivariate analysis, the following factors were independently associated with a higher risk of cytomegalovirus disease: the serostatus R-/D+ (seronegative recipients who received a kidney from a seropositive donor) (RR=35.7 [95%CI, 7.4-166.7]), treatment with mycophenolate (RR=10.4 [95%CI, 2.7-38.4]), and the development of any episodes of acute rejection (RR=10.1 [95%CI, 2.5-41.6]). These data show that kidney recipients receiving mycophenolate have a higher incidence of cytomegalovirus disease, mainly affecting the upper gastrointestinal tract, compared to those receiving azathioprine-based immunosuppression.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Azathioprine / adverse effects*
  • Bacterial Infections / complications*
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / adverse effects
  • Male
  • Middle Aged
  • Mycophenolic Acid / adverse effects*
  • Mycophenolic Acid / analogs & derivatives*
  • Mycoses / complications*
  • Opportunistic Infections / complications
  • Prospective Studies
  • Treatment Outcome
  • Virus Diseases / complications*


  • Immunosuppressive Agents
  • Mycophenolic Acid
  • Azathioprine