RESULTS OF CONVERSION FROM TRIPLE-DRUG TO DOUBLE-DRUG THERAPY IN LIVING - RELATED RENAL-TRANSPLANTATION

Results of 34 recipients of living related renal allografts initially treated with cyclosporine, azathioprine, and prednisolone and later el ectively converted to AZA and PRED are presented. Thirteen (group A), 14 (group B), and 7 (group C) patients were converted before 9 months, between 9 and 12 months, and after 12 months, respectively. Thirty-fo ur patients who were on AZA and PRED and had never received CsA served as controls. Of the 34 patients, 33 were HLA haploidentical with thei r donors and 1 was HLA identical. All patients received a mean 8.62+/- 7.39 third-party blood transfusions. In the control group, 29 patients received haploidentical grafts. The number of blood transfusions give n to this group was 7.09+/-9.13. Of the 34 patients receiving triple-d rug therapy, 9 (26%) had acute rejection within 3 months after convers ion, as compared with 5 (14.7%) in the control group (P>0.05). Althoug h 1 case had acute rejection before conversion, all recipients had sta ble graft function at the time of conversion. Of these 9 recipients, 7 had conversion over 4-7 weeks, while 2 had rapid conversion. Followin g treatment of the rejection episodes, 4 patients in the study group r esponded to therapy, as compared with 3 cases in the control group (P> 0.05). After a mean follow-up of 18.62+/-10.31 months (range 3-41 mont hs) following conversion, 4 patients were normal, 4 had chronic reject ion (mean serum creatinine = 3.0 mg/100 ml), and 1 was back on regular dialysis. Eventually, of the 34 patients who were converted from trip le-drug to double-drug therapy, 25 were normal, 5 had stable chronic r ejection, 2 were back on regular dialysis, 1 was retransplanted, and 1 died due to failed graft. At the end of follow-up, graft survival in the study group was 88.2%, as compared with 85.5% in controls (P>0.05) . We conclude that conversion from triple-drug to double-drug therapy is not without risk, even in living related primary renal transplantat ion. Degree of HLA matching, number of pretransplant blood transfusion s, and rejection before conversion did not have any significant effect on rejections following conversion, and the graft loss following conv ersion is unpredictable.