Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation
Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial e...
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| Veröffentlicht in: | The Lancet (British edition) 1995-03, Vol.345 (8950), p.610-614 |
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| creator | Hollander, A.A.M.J. van Saase, J.L.C.M. van Es, L.A. van derWoude, F.J. van Bockel, H.J. van Saase, J.L.C.M. Kootte, A.M.M. van Dorp, W.T. |
| description | Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75·3% in the cyclosporin group and 85·9% in the azathioprine group (p=0·14) and graft survival was 64·0% and 76·6%, respectively (p=0·38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0·71 (0·37-1·38) and the relative risk of patient death was 0·57 (0·23-1·41). The cyclosporin group had poorer mean creatinine clearance (17·8 mL/min [8·1-27·5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective. |
| doi_str_mv | 10.1016/S0140-6736(95)90520-0 |
| format | Article |
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However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75·3% in the cyclosporin group and 85·9% in the azathioprine group (p=0·14) and graft survival was 64·0% and 76·6%, respectively (p=0·38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0·71 (0·37-1·38) and the relative risk of patient death was 0·57 (0·23-1·41). The cyclosporin group had poorer mean creatinine clearance (17·8 mL/min [8·1-27·5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(95)90520-0</identifier><identifier>PMID: 7898178</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Acquired immune deficiency syndrome ; Adult ; AIDS ; Antihypertensives ; Azathioprine ; Azathioprine - economics ; Azathioprine - therapeutic use ; Biological and medical sciences ; Cadavers ; Conversion ; Creatinine ; Cyclosporine - economics ; Cyclosporine - therapeutic use ; Drug dosages ; Drug therapy ; Enzymes ; Female ; Follow-Up Studies ; Gout ; Graft Rejection - prevention & control ; Graft Survival - drug effects ; Grafting ; HIV ; Human immunodeficiency virus ; Humans ; Hypertension ; Immune Tolerance ; Immunomodulators ; Immunosuppression ; Immunosuppressive agents ; Internal medicine ; Kidney transplantation ; Kidney Transplantation - immunology ; Kidney transplants ; Kidneys ; Longitudinal Studies ; Male ; Medical research ; Medical sciences ; Middle Aged ; Patients ; Pharmacology. Drug treatments ; Prednisone ; Prednisone - therapeutic use ; Renal function ; Side effects ; Survival ; Survival Analysis ; Transplantation ; Transplants & implants ; Tuberculosis</subject><ispartof>The Lancet (British edition), 1995-03, Vol.345 (8950), p.610-614</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Mar 11, 1995</rights><rights>Copyright Elsevier Limited Mar 11, 1995</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4060-ac02e17589550844b1ce0fc02165a681b7399d3cd42aba13fb7b36dd886151af3</citedby><cites>FETCH-LOGICAL-c4060-ac02e17589550844b1ce0fc02165a681b7399d3cd42aba13fb7b36dd886151af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673695905200$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3463810$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7898178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hollander, A.A.M.J.</creatorcontrib><creatorcontrib>van Saase, J.L.C.M.</creatorcontrib><creatorcontrib>van Es, L.A.</creatorcontrib><creatorcontrib>van derWoude, F.J.</creatorcontrib><creatorcontrib>van Bockel, H.J.</creatorcontrib><creatorcontrib>van Saase, J.L.C.M.</creatorcontrib><creatorcontrib>Kootte, A.M.M.</creatorcontrib><creatorcontrib>van Dorp, W.T.</creatorcontrib><title>Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Immunosuppression with cyclosporin after renal transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75·3% in the cyclosporin group and 85·9% in the azathioprine group (p=0·14) and graft survival was 64·0% and 76·6%, respectively (p=0·38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0·71 (0·37-1·38) and the relative risk of patient death was 0·57 (0·23-1·41). The cyclosporin group had poorer mean creatinine clearance (17·8 mL/min [8·1-27·5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>Antihypertensives</subject><subject>Azathioprine</subject><subject>Azathioprine - economics</subject><subject>Azathioprine - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cadavers</subject><subject>Conversion</subject><subject>Creatinine</subject><subject>Cyclosporine - economics</subject><subject>Cyclosporine - therapeutic use</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Enzymes</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gout</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival - drug effects</subject><subject>Grafting</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Immune Tolerance</subject><subject>Immunomodulators</subject><subject>Immunosuppression</subject><subject>Immunosuppressive agents</subject><subject>Internal medicine</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - immunology</subject><subject>Kidney transplants</subject><subject>Kidneys</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisone</subject><subject>Prednisone - therapeutic use</subject><subject>Renal function</subject><subject>Side effects</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Tuberculosis</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU2LFDEQhoMo67j6ExaCetBDa6U7nyfRxS9Y8KCCJ0M6XcGsPcls0rMw_nozO8PcxFNI6nkrqSeEXDB4xYDJ11-BceikGuQLI14aED10cI-sGFe8E1z9uE9WJ-QheVTrNQBwCeKMnCltNFN6RX6-w4Qh-uhmiiGgXyrNgfqcbrHUmBMNJa-p3_k5100uMdElU_fHLb9i3rQtUhcWLPR3nBLu6FJcqpvZpcUtLf2YPAhurvjkuJ6T7x_ef7v81F19-fj58u1V5zlI6JyHHpkS2ggBmvOReYTQDpkUTmo2qsGYafAT793o2BBGNQ5ymrSWTDAXhnPy7NB3U_LNFutir_O2pHal7XswxrSxeaOe_otiRhulFOsbJA6QL7nWgsG2Mdeu7CwDuzdv78zbvVZrhL0zb6HlLo7Nt-Map1PqqLrVnx_rrno3hybKx3rCBi4HzfZt3hwwbLpuIxZbfcTkcYql_Y6dcvzPQ_4CDA2fng</recordid><startdate>19950311</startdate><enddate>19950311</enddate><creator>Hollander, A.A.M.J.</creator><creator>van Saase, J.L.C.M.</creator><creator>van Es, L.A.</creator><creator>van derWoude, F.J.</creator><creator>van Bockel, H.J.</creator><creator>van Saase, J.L.C.M.</creator><creator>Kootte, A.M.M.</creator><creator>van Dorp, W.T.</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope></search><sort><creationdate>19950311</creationdate><title>Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation</title><author>Hollander, A.A.M.J. ; van Saase, J.L.C.M. ; van Es, L.A. ; van derWoude, F.J. ; van Bockel, H.J. ; van Saase, J.L.C.M. ; Kootte, A.M.M. ; van Dorp, W.T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4060-ac02e17589550844b1ce0fc02165a681b7399d3cd42aba13fb7b36dd886151af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adult</topic><topic>AIDS</topic><topic>Antihypertensives</topic><topic>Azathioprine</topic><topic>Azathioprine - economics</topic><topic>Azathioprine - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cadavers</topic><topic>Conversion</topic><topic>Creatinine</topic><topic>Cyclosporine - economics</topic><topic>Cyclosporine - therapeutic use</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Enzymes</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gout</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival - drug effects</topic><topic>Grafting</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Immune Tolerance</topic><topic>Immunomodulators</topic><topic>Immunosuppression</topic><topic>Immunosuppressive agents</topic><topic>Internal medicine</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - immunology</topic><topic>Kidney transplants</topic><topic>Kidneys</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pharmacology. 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transplantation is associated with better graft survival than is azathioprine treatment. However, nephrotoxicity and other side-effects have led to regimens that change treatment to azathioprine shortly after transplantation. Conversion has beneficial effects in the short term on renal function and hypertension. We report long-term follow-up (minimum 5 years) of 128 patients who had received a first or second cadaveric kidney graft and were treated with cyclosporin and prednisone; they were randomly assigned 3 months after transplantation to groups continuing to receive cyclosporin (n=68) or changing to azathioprine (n=60). 8 years after transplantation, patient survival was 75·3% in the cyclosporin group and 85·9% in the azathioprine group (p=0·14) and graft survival was 64·0% and 76·6%, respectively (p=0·38). The frequency of cardiovascular death with a functioning graft was 8% higher in the cyclosporin group (95% Cl -1 to 18). The relative risk of graft loss after conversion to azathioprine compared with cyclosporin maintenance was 0·71 (0·37-1·38) and the relative risk of patient death was 0·57 (0·23-1·41). The cyclosporin group had poorer mean creatinine clearance (17·8 mL/min [8·1-27·5] lower than azathioprine group) and a higher proportion needed hypertensive drugs (20% [4-36] more). Gout was found in 9 cyclosporin-treated patients and 1 azathioprine-treated patient (difference 12% [3 to 20]). Elective conversion from cyclosporin to azathioprine 3 months after transplantation is safe and cost-effective.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>7898178</pmid><doi>10.1016/S0140-6736(95)90520-0</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 1995-03, Vol.345 (8950), p.610-614 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_journals_2209996054 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Business Source Complete |
| subjects | Acquired immune deficiency syndrome Adult AIDS Antihypertensives Azathioprine Azathioprine - economics Azathioprine - therapeutic use Biological and medical sciences Cadavers Conversion Creatinine Cyclosporine - economics Cyclosporine - therapeutic use Drug dosages Drug therapy Enzymes Female Follow-Up Studies Gout Graft Rejection - prevention & control Graft Survival - drug effects Grafting HIV Human immunodeficiency virus Humans Hypertension Immune Tolerance Immunomodulators Immunosuppression Immunosuppressive agents Internal medicine Kidney transplantation Kidney Transplantation - immunology Kidney transplants Kidneys Longitudinal Studies Male Medical research Medical sciences Middle Aged Patients Pharmacology. Drug treatments Prednisone Prednisone - therapeutic use Renal function Side effects Survival Survival Analysis Transplantation Transplants & implants Tuberculosis |
| title | Beneficial effects of conversion from cyclosporin to azathioprine after kidney transplantation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T23%3A35%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Beneficial%20effects%20of%20conversion%20from%20cyclosporin%20to%20azathioprine%20after%20kidney%20transplantation&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Hollander,%20A.A.M.J.&rft.date=1995-03-11&rft.volume=345&rft.issue=8950&rft.spage=610&rft.epage=614&rft.pages=610-614&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(95)90520-0&rft_dat=%3Cproquest_cross%3E1699411%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=198977712&rft_id=info:pmid/7898178&rft_els_id=S0140673695905200&rfr_iscdi=true |