Conversion From Cyclosporine To Azathioprine At One Year After HLA-Identical Living Related Renal Transplantation: 12 Year Follow Up.

Abstract

561 Since 1984 it has been the policy at our institution to convert 2 haplotype matched living related kidney transplant patients with stable renal function at one year from cyclosporine (CSA) to azathioprine (AZA). We now analyze the outcomes of these patients. From Jan., 1984 to Dec., 1996, 46 HLA-identical living related kidney transplant patients were started on CSA (10mg/kg/d, dose adjusted by troughs) and Prednisone (20mg/kg/d initially and tapered to 15mg qod at 1 yr). 40 of these patients were converted to AZA (1.5-2.5mg/kg/d) at one year post transplant. 1 patient was switched back to CSA because of pancytopenia. 5 of the remaining 39 patients have been lost to follow up. 19/34 patients (56%) are alive with excellent graft function: mean creatinine 1.38mg/dl (range 0.8-2.2mg/dl), mean follow up 4.6 yr (range 1-12 yr). 4/34 patients (12%) died with functioning grafts. 12 patients no longer have functioning grafts. 5/34 patients (15%) had biopsy proven recurrence of their primary renal disease. 3/34 patients (9%) lost graft function secondary to mechanical problems (1 chronic obstruction and 2 vascular complications). The remaining 4 patients lost grafts to rejection. In all cases graft loss was secondary to noncompliance. Of note, not one of the patients switched to AZA had an episode of rejection at the time of conversion. All 4 of the patients with eventual rejection had stable renal function following conversion to AZA, mean follow up 4.3 yr. In summary, at our institution 0 of 40 HLA-identical patients demonstrating stable renal function at one year post transplantation experienced rejection and graft loss after conversion to AZA. Moreover, of the remaining, compliant patients who have not lost their grafts to recurrent disease or mechanical complications, all continue to demonstrate excellent graft function as far out as 12 years. We conclude that in HLA-identical living related transplant recipients it is not only safe but beneficial to convert from CSA to AZA at one year.