Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation

Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial e...

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Bibliographic Details
Published in:The Lancet (British edition) 1995-03, Vol.345 (8950), p.610-614
Main Authors: Hollander, A.A.M.J., van Saase, J.L.C.M., van Es, L.A., van derWoude, F.J., van Bockel, H.J., Kootte, A.M.M., van Dorp, W.T.
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Antihypertensives
Azathioprine
Azathioprine - economics
Azathioprine - therapeutic use
Biological and medical sciences
Cadavers
Conversion
Creatinine
Cyclosporine - economics
Cyclosporine - therapeutic use
Drug dosages
Drug therapy
Enzymes
Female
Follow-Up Studies
Gout
Graft Rejection - prevention & control
Graft Survival - drug effects
Grafting
HIV
Human immunodeficiency virus
Humans
Hypertension
Immune Tolerance
Immunomodulators
Immunosuppression
Immunosuppressive agents
Internal medicine
Kidney transplantation
Kidney Transplantation - immunology
Kidney transplants
Kidneys
Longitudinal Studies
Male
Medical research
Medical sciences
Middle Aged
Patients
Pharmacology. Drug treatments
Prednisone
Prednisone - therapeutic use
Renal function
Side effects
Survival
Survival Analysis
Transplantation
Transplants & implants
Tuberculosis
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Summary:Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75·3% in the cyclosporin group and 85·9% in the azathioprine group (p=0·14) and graft survival was 64·0% and 76·6%, respectively (p=0·38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0·71 (0·37-1·38) and the relative risk of patient death was 0·57 (0·23-1·41). The cyclosporin group had poorer mean creatinine clearance (17·8 mL/min [8·1-27·5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(95)90520-0