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Nephrol Dial Transplant (2000) 15: 1228-1231
© 2000 European Renal Association-European Dialysis and Transplant Association

Randomized trial of conversion from mycophenolate mofetil to azathioprine 6 months after renal allograft transplantation

Rudolf P. Wüthrich, Snjezana Cicvara, Patrice M. Ambühl and Ulrich Binswanger

Division of Nephrology, Department of Medicine, University Hospital, Zürich, Switzerland

Background. In the first year after renal allograft transplantation, triple therapy immunosuppression with cyclosporin (CsA), prednisone (P), and mycophenolate mofetil (MMF) is superior to a triple therapy treatment that includes azathioprine (AZA) instead of MMF. Whether long-term treatment with CsA-P-MMF is better than treatment with CsA-P-AZA is a matter of debate, as 3-year graft survival is similar in MMF- and AZA-treated patients. The purpose of the present study was to examine the short-term effect of changing MMF to AZA in low-risk renal allograft recipients 6 months after transplantation.

Method. This was a randomized, open-label single-centre study, recruiting 48 low risk renal allograft recipients on CsA-P-MMF therapy 6 months after transplantation, comparing the outcome with continued MMF treatment (2 g b.i.d.) (group A, n=22) or switching MMF to AZA (1 mg/kg) treatment (group B, n=26).

Results. The outcome after a 6-months follow-up of patients in group A and group B was similar. Treatment failure rates (defined as clinically diagnosed acute rejection episodes) were 4.5% in group A and 3.8% in group B. There were no patient deaths and no graft failures during the 6-months observation period. Graft function was excellent and similar in both groups.

Conclusion. Replacing MMF with AZA 6 months after transplantation in low-risk renal allograft recipients is safe and is not associated with altered graft function in the short term.

Keywords: CsA dosage; low-risk kidney transplant recipients; mycophenolate mofetil to azathioprine conversion; prednisone; short-term graft survival; six-month trial

Correspondence and offprint requests to: Rudolf P. Wüthrich, Division of Nephrology, Kantonsspital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland.


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