Cyclosporine withdrawal in stable renal transplant recipients after azathioprine-mycophenolate mofetil conversion

Background: Cyclosporine A (CsA) nephrotoxicity is a nonimmunologic factor of chronic allograft dysfunction (CAD) in kidney transplant recipients. Myc ophenolate mofetil (MMF) may allow CsA dosage reduction or even complete wi thdrawal in selected populations with CsA nephrotoxicity or CAD. The aim of the present study was to evaluate the efficacy and safety of CsA withdrawa l after azathioprine (AZA)-MMF conversion in a population of stable renal t ransplant recipients. Methods: Twenty-eight first cadaver kidney recipients were included, AZA wa s then discontinued, MMF was introduced and after 4 months CsA was complete ly withdrawn. All patients underwent inuline clearance measurement and rena l biopsy at inclusion and at the end of the follow-up (40 wk). Results: CsA was completely discontinued in 20 patients, No patient lost hi s graft during the study period, but I patient experienced a reversible acu te rejection episode. Inuline clearance improved significantly in the whole series. At the end of follow-up, histological worsening was observed in 50 % of patients without any specific risk factor, In these patients, inuline clearance did not improve. Systolic blood pressure, the need for anti-hyper tensive drugs and HDL cholesterol improved. Conclusion: In stable kidney transplant recipients, CsA withdrawal after AZ A replacement by MMF switch was safe with regard to acute rejection, It imp roved blood pressure and the lipid profile, but, in 50% of patients was ass ociated with histologic deterioration.