Elective conversion from cyclosporin to azathioprine in living related donor kidney transplants

Thirty-five patients with living related donor kidney transplants who were initially immunosuppressed with cyclosporin and a small dose of prednisolone were electively converted to receive azathioprine. Conversion was carried out 6 months after initiation of cyclosporin therapy. Cyclosporin was initially given as part of a random study in 13 cases (group I), and due to the presence of immunological high-risk factor(s) or to control steroid-resistant rejection episodes in 22 cases (group II). In group I, three cases developed acute rejection symptoms which were easily controlled. In group II, conversion was followed by acute rejection episodes in six patients. In two cases these were easily controlled. In four cases the episodes were unsuccessfully controlled, even after reintroduction of cyclosporin. We conclude that conversion from cyclosporin to azathioprine in living related donor kidney transplant patients at 6 months is a safe and beneficial practice in immunologically stable cases, but hazardous in those with high-risk immunological factors.