The role of mycophenolate mofetil in kidney transplantation revisited

Transplant Rev (Orlando). 2014 Jan;28(1):26-31. doi: 10.1016/j.trre.2013.10.005. Epub 2013 Oct 25.


Since its regulatory approval in 1995, mycophenolate mofetil (MMF) has largely replaced azathioprine (AZA) as the anti-metabolite immunosuppressive of choice in kidney transplantation. While the initial industry-sponsored clinical trials suggested strong reductions in the incidence of acute rejection in the first six months post transplantation, long-term follow-up studies have failed to demonstrate a similar degree of benefit in overall graft and patient survival. In addition, several subsequent studies have raised questions on the potential attenuating effects of calcineurin inhibitor choice on MMF efficacy when compared to AZA. This review will revisit the question of whether the available evidence continues to support the superiority of MMF over AZA in kidney transplantation outcomes while comprehensively reviewing the available evidence from clinical trial data, systematic reviews, and registry studies.

Publication types

  • Review

MeSH terms

  • Clinical Trials as Topic
  • Graft Rejection / drug therapy*
  • Graft Rejection / prevention & control*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use


  • Immunosuppressive Agents
  • Mycophenolic Acid