Is there an advantage in adding azathioprine to prednisone and cyclosporine in kidney transplant recipients?
Some recent studies have raised doubts about the advantage of adding azathioprine to cyclosporine and prednisone ("triple therapy") in kidney transplant patients. We reviewed the charts of 53 patients followed at our center after they received a living non-related kidney transplant in India. Thirty-eight patients used "triple therapy" (cyclosporine, prednisone and azathioprine) and 15 patients "double therapy" (cyclosporine and prednisone). A multi-variate analysis was used to study the differences in gender, age, follow-up period, number of patients with at least one acute rejection episode, number of significant infections, cyclosporine dosage and trough levels, prednisone dosage, transplant function, and graft loss due to rejection. There was no difference in the number of acute rejections or graft loss due to rejection in both treatment groups. Although the mean cyclosporine levels at 6, 12 and 24 months and the mean dosage at 6 and 12 months were significantly lower in the triple therapy group, there was no significant differences in these parameters between the patients with and without rejection. The cyclosporine levels at the time of rejection were also not different from the levels in the patients without rejection. The results support other reports suggesting that azathioprine does not seem to add to the immunosuppressive effect, as it is not associated with a lower incidence of acute rejections or an improved graft survival.
Hussein
M
M
Department of Nephrology and Dialysis, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
Mooij
J
J
Roujouleh
H
H