PROSPECTIVE RANDOMIZED STUDY OF AZATHIOPRINE VERSUS CYCLOSPORINE IN LIVE-DONOR KIDNEY-TRANSPLANTATION

A total of 112 recipients of haploidentical live-related donor kidney transplants were assigned randomly prior to transplantation to two gro ups of immunosuppressive treatment. The first group (54 patients) rece ived the conventional immunotherapy of azathioprine (AZA) and predniso lone (P; AZA-P group). In the second group, 58 patients were given cyc losporin (Cs) and P (Cs-P group). All patients had previous third-part y blood transfusions. The follow-up period ranged from 3 to 6 years (m ean 50 +/- 8 months) during which 13 patients (24%) in the AZA-P group and 6 (10%) in the Cs-P group were switched to the alternate immunoth erapy (p > 0.05). Analysis of patient and graft survival along the fol low-up period did not disclose significant differences between patient s of the two groups. While the overall frequency of acute rejection ep isodes was not significantly different between the two treatment group s, the number of patients who had 2 or more rejection episodes was hig her in the AZA-P group (p < 0.04). The mean serum creatinine levels we re significantly higher in the Cs-P group than corresponding levels in the AZA-P group at 1, 12 and 24 months after transplantation. We have concluded that at least 75% of the haploidentical human lymphocyte an tigen mismatched live-related donor renal transplants can be maintaine d on AZA-P immunotherapy with a comparable degree of success to those treated with Cs-P. However, in at least 15% of patients with conventio nal immunotherapy, Cs could reverse ongoing rejections, and therefore, it can be considered as a rescue treatment in AZA-treated patients wi th steroid-resistant or ongoing rejections.