A randomised, prospective study on the conversion from cyclosporine‐prednisone to cyclosporine‐azathioprine at 6 months after renal transplantation

In a randomised prospective trial, we studied the effects of replacement of prednisone (Pred) by azathioprine (Aza), 6 months after transplantation, in stable renal allograft recipients on cyclosporine and prednisone (CsA+Pred). Out of 83 patients, 42 started treatment with CsA+Aza and 41 continued therapy with CsA+Pred. CsA was dosed to achieve a level of 150 ng/ml, the Aza dose was 3 mg/kg per day and the Pred dose was 0.15 mg/kg per day. Eighteen months after randomisation, in the CsA+Aza group 18 of the 42 patients were effectively treated with CsA+Aza. In the main, anaemia, leuco- and thrombocytopenia, and hypocorticism necessitated the reintroduction of Pred in the remaining 24 patients. Compared to the continuation of CsA+Pred, conversion of Pred to Aza resulted in a reduced number of antihypertensive drugs needed, and in lower serum total, LDL and HDL cholesterol levels; the incidence of acute rejections and graft losses was no different. In conclusion, conversion of CsA+Pred to CsA+Aza is a safe option in renal transplant patients with contraindications to long-term corticosteroid treatment.