Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.transproceed.2004.08.104
Title: Conversion from mycophenolate mofetil to azathioprine in high-risk renal allograft recipients on cyclosporine-based immunosuppression
Authors: Lou, HX
Vathsala, A 
Keywords: Azathioprine
Creatinine
Cyclosporine
Drug Therapy, Combination
Female
Graft Rejection
Humans
Immunosuppressive Agents
Kidney Transplantation
Male
Middle Aged
Mycophenolic Acid
Transplantation, Homologous
Issue Date: 1-Sep-2004
Publisher: Elsevier BV
Citation: Lou, HX, Vathsala, A (2004-09-01). Conversion from mycophenolate mofetil to azathioprine in high-risk renal allograft recipients on cyclosporine-based immunosuppression 36 (7) : 2090-2091. ScholarBank@NUS Repository. https://doi.org/10.1016/j.transproceed.2004.08.104
Abstract: Objective. In a randomized control trial of mycophenolate mofetil (MMF) versus azathioprine (AZA) with cyclosporine and steroids, we demonstrated that MMF reduced acute rejection (AR) among renal allograft recipients (RTX) who were of low to moderate risk. However, 10% had AR when converted from MMF to AZA at 6 months, postrenal transplantation (RT). Two clinical markers, abnormal serum creatinine (SCr) and proteinuria at 6 months, post-RT, were associated with AR postconversion. The present study examined the safety of such conversion in selected high-risk RTX at 1 year of MMF therapy. Methods. Thirteen high-risk RTX receiving MMF for either high panel reactive antibody (n = 9) or following AR (n = 4), with normal SCr and no proteinuria at 1 year, were selected for conversion. The incidence of AR, adverse events, and renal parameters (SCr, creatinine clearance, proteinuria) at 6 months postconversion was evaluated. Eight high-risk RTX who did not meet these selection criteria were retrospectively reviewed and used as controls. Results. Renal parameters (SCr 123 ± 26 vs 129 ± 27 μmol/L; pre- vs postconversion) were not significantly different; no episodes of AR or proteinuria were documented. Azathioprine was discontinued in two patients due to leukopenia. In the control group, one patient had graft loss from chronic rejection, whereas one developed posttransplant lymphoproliferative disease necessitating MMF withdrawal. Conclusion. These results suggest that selective conversion from MMF to AZA after 1 year is safe, even in high-risk RTX. Normal SCr and absence of proteinuria are good screening parameters to identify patients at low risk for AR following such conversion.
URI: https://scholarbank.nus.edu.sg/handle/10635/229717
ISSN: 00411345
18732623
DOI: 10.1016/j.transproceed.2004.08.104
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