Azathioprine monotherapy in HLA-identical live donor kidney transplant recipients.
The high success rate of HLA-identical sibling transplants and our previous experience with steroid-free immunosuppressive regimens and cyclosporine withdrawal prompted us to evaluate the safety and efficacy of monotherapy with azathioprine in 12 HLA-identical kidney transplant recipients with a serum creatinine concentration less than 176.8 mumol/L, a 1-way stimulatory index less than 2.0 in a post-transplant mixed lymphocyte culture, and a demonstrated tolerance of a minimum azathioprine dose of 1.0 mg/kg per day without leukopenia. Eleven of 12 patients were successfully converted to azathioprine monotherapy without a significant change in serum creatinine concentration for as long as 76 months. Benefits of steroid and cyclosporine withdrawal included a significant reduction in mean systolic and diastolic blood pressure, number of blood pressure medications, total serum cholesterol, and glycohemoglobin in diabetic subjects. Our results suggest that azathioprine monotherapy is safe and effective in a select group of HLA-identical sibling transplants, but these benefits must be carefully balanced against an associated risk of precipitating acute allograft rejection.
Transplantation Service, University Hospitals of Cleveland, Ohio, USA.
M R
MR
Bartucci
S
S
Flemming-Brooks
B
B
Koshla
T C
TC
Knauss
D E
DE
Hricik
J A
JA
Schulak
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003404:Creatinine; D001379:Azathioprine