BENEFICIAL-EFFECTS OF CONVERSION FROM CYCLOSPORINE TO AZATHIOPRINE AFTER KIDNEY-TRANSPLANTATION

被引:145
|
作者
HOLLANDER, AAMJ
VANSAASE, JLCM
KOOTTE, AMM
VANDORP, WT
VANBOCKEL, HJ
VANES, LA
VANDERWOUDE, FJ
机构
[1] UNIV LEIDEN HOSP,DEPT SURG,2300 RC LEIDEN,NETHERLANDS
[2] ST CLARA HOSP,DEPT INTERNAL MED,ROTTERDAM,NETHERLANDS
[3] RIJNLAND HOSP,DEPT INTERNAL MED,ALPHEN AAN DE RIJN,NETHERLANDS
[4] KENNEMER GASTHUIS,DEPT INTERNAL MED,HAARLEM,NETHERLANDS
来源
LANCET | 1995年 / 345卷 / 8950期
关键词
D O I
10.1016/S0140-6736(95)90520-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75.3% in the cyclosporin group and in the azathioprine group 85.9% (p=0.14) and graft survival was 64.0% and 76.6%, respectively (p=0.38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0.71 (0.37-1.38) and the relative risk of patient death was 0.57 (0.23-1.41). The cyclosporin group had poorer mean creatinine clearance (17.8 ml/min [8.1-27.5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective.
引用
收藏
页码:610 / 614
页数:5
相关论文
共 50 条
  • [11] THE IMPACT OF AZATHIOPRINE AND CYCLOSPORINE ON LONG-TERM FUNCTION IN KIDNEY-TRANSPLANTATION
    MONTAGNINO, G
    COLTURI, C
    TARANTINO, A
    MASA, A
    BANFI, G
    AROLDI, A
    VIGANO, E
    CESANA, B
    PONTICELLI, C
    TRANSPLANTATION, 1991, 51 (04) : 772 - 776
  • [12] SOMATIC GROWTH AFTER KIDNEY-TRANSPLANTATION - BENEFICIAL EFFECT OF CYCLOSPORINE IN COMPARISON WITH CONVENTIONAL IMMUNOSUPPRESSION
    OFFNER, G
    HOYER, PF
    JUPPNER, H
    KROHN, HP
    BRODEHL, J
    AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1987, 141 (05): : 541 - 546
  • [13] CYCLOSPORINE-A MONOTHERAPY AFTER KIDNEY-TRANSPLANTATION
    TAMM, M
    HUSER, B
    BRUNNER, F
    MIHATSCH, M
    LANDMANN, J
    THIEL, G
    KIDNEY INTERNATIONAL, 1989, 36 (02) : 317 - 317
  • [14] CYCLOSPORINE IN KIDNEY-TRANSPLANTATION
    LANG, P
    BUISSON, C
    PRESSE MEDICALE, 1987, 16 (29): : 1398 - 1400
  • [15] AZATHIOPRINE IS NECESSARY IN KIDNEY-TRANSPLANTATION
    TOUSSAINT, C
    KINNAERT, P
    VEREERSTRAETEN, P
    DUPONT, E
    VANGEERTRUYDEN, J
    TRANSPLANTATION, 1979, 27 (02) : 145 - 146
  • [16] Beneficial effects of conversion from cyclosporine to azathioprine on fibrinolysis in renal transplant recipients
    van den Dorpel, MA
    Levi, M
    Ijzermans, JN
    ten Cate, JW
    Weimar, W
    TRANSPLANTATION PROCEEDINGS, 1999, 31 (1-2) : 329 - 329
  • [17] Beneficial effects of conversion from cyclosporine to azathioprine on fibrinolysis in renal transplant recipients
    van den Dorpel, MA
    Man in't Veld, AJ
    Levi, M
    ten Cate, JW
    Weimar, W
    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 1999, 19 (06) : 1555 - 1558
  • [18] BENEFICIAL-EFFECTS OF PROPHYLACTIC OKT3 IN CADAVER KIDNEY-TRANSPLANTATION - COMPARISON WITH CYCLOSPORINE-A IN A SINGLE-CENTER PROSPECTIVE RANDOMIZED STUDY
    GOLDMAN, M
    ABRAMOWICZ, D
    DEPAUW, L
    MARECAUX, G
    VANDERWINDEN, JM
    KINNAERT, P
    VEREERSTRAETEN, P
    TRANSPLANTATION PROCEEDINGS, 1991, 23 (01) : 1046 - 1047
  • [19] THE BENEFICIAL-EFFECTS OF THORACIC-DUCT DRAINAGE IN HLA-1 HAPLOTYPE IDENTICAL KIDNEY-TRANSPLANTATION
    OHSHIMA, S
    ONO, Y
    KINUKAWA, T
    MATSUURA, O
    TAKEUCHI, N
    HATTORI, R
    JOURNAL OF UROLOGY, 1987, 138 (01): : 33 - 35
  • [20] MONOTHERAPY WITH CYCLOSPORINE IN KIDNEY-TRANSPLANTATION
    ANDREU, J
    CAMPISTOL, JM
    OPPENHEIMER, F
    RICART, MJ
    VILARDELL, J
    CARRETERO, P
    TRANSPLANTATION PROCEEDINGS, 1990, 22 (05) : 2270 - 2271