Long-term outcome of a prospective randomized trial of conversion from cyclosporine to azathioprine treatment one year after renal transplantation

• Published in: Transplantation Vol. 66; no. 9; p. 1186
• Main Authors: MacPhee, I A, Bradley, J A, Briggs, J D, Junor, B J, MacPherson, S G, McMillan, M A, Rodger, R S, Watson, M A
• Format: Journal Article
• Language: English
• Published: United States 15.11.1998
• Subjects: Acute Disease; Adolescent; Adult; Aged; Azathioprine - adverse effects; Azathioprine - therapeutic use; Blood Pressure; Cardiovascular Diseases - etiology; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Female; Follow-Up Studies; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; Infection - etiology; Kidney - physiology; Kidney Transplantation - immunology; Male; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome
• ISSN: 0041-1337
• DOI: 10.1097/00007890-199811150-00013

Since the introduction of cyclosporine (CsA), 1-year renal allograft survival has improved, but concern persists about the long-term adverse effects of CsA, especially with respect to renal function and blood pressure. This randomized controlled trial was set up to establish whether withdrawal of CsA would alter long-term outcome. Adult patients who, at 1 year after renal transplantation, had a stable serum creatinine of less than 300 micromol/L and who had not had acute rejection within the last 6 months were eligible for entry. Patients were randomized either to continue on CsA (n=114) or to stop CsA and start azathioprine (Aza, n=102). All patients remained on prednisolone. Median follow-up was 93 months after transplantation (range: 52-133 months). There was no significant difference in actuarial 10-year patient or graft survival (Kaplan-Meier), despite an increased incidence of acute rejection within the first few months after conversion. Median serum creatinine was lower in the Aza group (Aza: 119 micromol/L; CsA. 153 micromol/L at 5 years after randomization, P=0.0002). The requirement for antihypertensive treatment was also reduced after conversion to Aza; 75% of patients required antihypertensive treatment at the start of the study, decreasing to 55% from 1 year after randomization in the Aza group and increasing to >80% in the CsA group (55% (Aza) and 84% (CsA) at 5 years after randomization, P<0.005). Conversion from CsA to Aza at 1 year after renal transplantation results in improvement in both blood pressure control and renal allograft function, and is not associated with significant adverse effects on long-term patient or graft survival.