Azathioprine vs cyclosporine in recipients of HLA-identical renal allografts

BACKGROUND 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 HLAidentical siblings.

METHODS Retrospective review.

RESULTS 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 azathioprinetreated patients and 9 6% and 83%, respectively, for cyclosporinetreated 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 Maintenance steroid therapy was successfully withdrawn in six azathioprinetreated patients and seven cyclosporine-treated patients.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.