Azathioprine vs cyclosporine in recipients of HLA-identical renal allografts
Inderbir S. Gill, MD
Ernest E. Hodge, MD
Andrew C. Novick, MDAddress reprint requests to A.C.N., Department of Urology, A100, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Stevan B. Streem, MD
William E. Braun, MD
Lata Paranandi, MSHP
Siblings with identical human leukocyte antigens (HLA) are preferred transplant donors.OBJECTIVE
To compare the outcomes in azathioprine-treated and cyclosporine-treated recipients of renal transplants from HLA-identical siblings.METHODS
From August 1980 to June 1989, 53 consecutive patients received renal transplants from HLA-identical donors. These patients received prednisone and either azathioprine (n = 26) or cyclosporine (n = 27). A mean of 8.4 years elapsed since transplantation in the azathioprine-treated patients and 4.7 years elapsed in the cyclosporine-treated patients. The 5-year patient and graft survival rates were 100% and 92%, respectively, for azathioprine-treated patients and 96% and 83%, respectively, for cyclosporine-treated patients (P = .379 for comparison of graft survival). There was no difference between the two groups in the number of rejections or the time to the first rejection episode. At 5 years after transplantation, cyclosporine-treated patients had a significantly higher median serum creatinine concentration (1.7 mg/dL) than did azathioprine-treated patients (1.3 mg/dL, P = .018). Maintenance steroid therapy was successfully withdrawn in six azathioprine-treated patients and seven cyclosporine-treated patients.CONCLUSIONS
Azathioprine and cyclosporine produce equally satisfactory outcomes in this immunologically favored group. The need for continued steroid therapy in these patients requires further study.