Wits Journal of Clinical Medicine

Introduction: Mycophenolate mofetil (MMF) has, to a great extent, replaced azathioprine (AZA) in immunosuppressive regimens worldwide in the prevention of acute allograft rejection. However, there are no studies in South Africa to show that MMF is superior to AZA.

Objectives: To describe the outcomes of cadaveric renal transplantation in patients treated with either MMF or AZA and followed up over a 5-year period.

Design: This was a retrospective comparative study.

Methods: A convenience sample of all eligible patients, 208 in total, was recruited from the Renal Transplant Unit at the Charlotte Maxeke Johannesburg Academic Hospital from 1985 to 2013, who were treated with either MMF or AZA.

Results: Of the 208 patients, 101 patients were treated with AZA and 107 patients treated with MMF, in addition to corticosteroids and cyclosporine. A total of 16 patients developed acute allograft rejection 12–52 weeks after cadaveric transplantation. Of these, 6% were in the AZA group and 10% in the MMF group. There was a 1% mortality in the MMF group and 16.8% in the AZA group (p < 0.001). The serum creatinine at a 3-month follow-up was found to be a strong predictor of allograft function in patients on MMF (p < 0.001).

Conclusion: Patient survival was superior in the long term in cadaveric renal transplant patients receiving MMF therapy.

The introduction of a system such as the National Health Insurance is borne of the intention to create and promote equitable and accessible health care. Health-care delivery within the South African context echoes the economic divide in the country, where access to private health service is primarily by the skilled, educated and affluent sector of the population, leaving the poor marginalized. Solid organ transplantation requires an extensive skill set as well as intense human, financial and institutional resources. As a consequence, transplantation centres in South Africa are restricted to a few centres of excellence. With regards to liver transplantation, there are only two transplant centres in the South Africa; Wits Donald Gordon Medical Centre (WDGMC), a private academic hospital in Johannesburg, and the other, a public sector unit in Cape Town.

Background: Despite the enlarging pool of paediatric liver transplants (LT), there is a paucity of data-detailing risk factors for acute cellular rejection (ACR).

Objective: To identify risk factors associated with ACR.

Method: We reviewed the data of 98 paediatric patients at Wits Donald Gordon Medical Centre who underwent LT between 2015 and 2018, and subsequent histologically determined ACR.

Results: Of the 98 patients who received a LT, 52% of donors were deceased donors and 48% were living donors. Twenty-two per cent of the patients were diagnosed with ACR during the first 90 days post LT. Sixty-eight per cent of living donor liver transplants were in the shortest (less than 2.5 h) cold ischaemic time (CIT) tertile, while 0% of deceased donor organs were transplanted prior to 2.5 h. We identified decreased CIT and living donor status as factors, both closely related to each other and associated with a decreased risk of ACR.

Conclusion: CIT is associated with a decreased risk of ACR. Living donor LT is associated with a decreased CIT and as a result a less inflammatory milieu in the early post LT period. Further research should be conducted, with particular reference to a decreased risk of ACR in living donor paediatric LT, in order to better inform immunosuppressive therapeutic regimens.