Elsevier

The Lancet

Volume 345, Issue 8950, 11 March 1995, Pages 610-614
The Lancet

Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation

https://doi.org/10.1016/S0140-6736(95)90520-0Get rights and content

Abstract

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.

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