Conversion of stable renal allografts at one year from cyclosporin A to azathioprine: a randomized controlled study.
Seventy-seven stable, nondiabetic, cadaveric renal transplants were randomized at 1 year to convert from cyclosporin A to azathioprine or to continue on cyclosporin A. Prednisolone was increased twofold during the period of conversion, and there was a 3-week overlap period during which azathioprine and cyclosporin A were given. No grafts were lost due to rejection related to conversion, but 9 of the 33 patients who were randomized to convert experienced rejection episodes and 6 were returned to cyclosporin A. Conversion to azathioprine resulted in a drop in creatinine and improvement in blood pressure control. In the group randomized to stay on cyclosporin A, 6 patients had to be subsequently converted to azathioprine because of cyclosporin A toxicity in spite of well-controlled plasma levels. The creatinine levels after successful conversion remained stable whereas those of the patients continuing on cyclosporin A showed a progressive decline. We conclude that conversion from cyclosporin A to azathioprine can be achieved safely. Progressive deterioration in graft function with continuing cyclosporin A therapy does occur and should be taken as an indication for conversion.
Sweny
P
P
Renal Transplant Unit, Royal Free Hospital, London, UK.
Lui
S F
SF
Scoble
J E
JE
Varghese
Z
Z
Fernando
O N
ON
Moorhead
J F
JF
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000378:metabolism; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D011239:Prednisolone / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D003524:Cyclosporins; D011239:Prednisolone; D003404:Creatinine; D001379:Azathioprine