Azathioprine withdrawal in renal transplant recipients. A long-term follow-up

Azathioprine (AZTP) must sometimes be discontinued in cadaveric kidney recipients. Long-term survival of patients after AZTP withdrawal is questionable, and many groups consider that maintenance treatment with AZTP is preferable to its discontinuation despite potential severe side effects. In our group AZTP had to be discontinued in 39 recipients of first renal allografts (30 cadaver kidney recipients, 9 living-related recipients) because of severe liver disease or cancer. The median follow-up period after AZTP withdrawal was 32 months, ranging from 5 to 84 months. Deterioration of renal function, which occurred in 11 (28.2%) patients, was more frequently observed in recipients of an incompatible graft (2-4 HLA-A and B mismatches (P = 0.02)). The graft survival rate of 56.9% at 10 years for the whole group of patients compares favorably with the 63.2% graft survival rate of a matched control group of 79 patients. Thus, AZTP may be discontinued whenever required without increasing the rate of graft loss.