Post-transplant conversion from cyclosporin to azathioprine: effect on cardiovascular risk profile

Authors

  • R. Sutherland,

    Corresponding author
    1. Department of Surgery, University of Calgary Foothills Hospital, 1403 29th Street N.W., Calgary, Alberta, Canada T2N 2T9
      Health Sciences Centre, 3330 Hospital Drive N. W., Calgary, Alberta, Canada T2N 4N1
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  • E. Burgess,

    1. Department of Medicine, University of Calgary, Foothills Hospital, 1403 29th Sreet N. W., Calgary. Alberta, Canada T2N 2T9
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  • J. Klassen,

    1. Department of Medicine, University of Calgary, Foothills Hospital, 1403 29th Sreet N. W., Calgary. Alberta, Canada T2N 2T9
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  • S. Buckle,

    1. Department of Medicine, University of Calgary, Foothills Hospital, 1403 29th Sreet N. W., Calgary. Alberta, Canada T2N 2T9
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  • L. C. Paul

    1. Department of Medicine, University of Calgary, Foothills Hospital, 1403 29th Sreet N. W., Calgary. Alberta, Canada T2N 2T9
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Health Sciences Centre, 3330 Hospital Drive N. W., Calgary, Alberta, Canada T2N 4N1

Abstract

Abstract The benefits of long-term cyclosporin (CyA) therapy are not yet established and must be weighed against its toxicity. We studied cardiovascular risk factors in 25 patients who received a kidney transplant between 1985 and 1989 and in whom CyA was discontinued. The protocol for discontinuing CyA involved starting azathioprine (Aza) and then weaning CyA over 6 weeks without changing the prednisone dose. Parameters collected from the patients' charts 3 months before (pre) and 3 months after conversion (post) and at the most current follow-up (cur) included serum creatinine, cholesterol, blood pressure, and anti-hypertensive medication. The severity of the hypertension was graded, based on a hypertension index reflecting the nature and dose of the anti-hypertensive medication. Of the 25 patients in whom CyA was discontinued, 2 experienced a rejection episode during conversion and were switched back to CyA; 1 patient had a rejection episode after conversion but remained on Aza. Converted patients demonstrated improved renal function (1/Cr pre 0.69 ± 0.20, post 0.84 ± 0.23, P < 0.05), lower serum cholesterol levels (pre 6.8 ± 1.0, post 5.8 ± 1.2, P < 0.05), lower meanarterialpressure(prelll ± 14, postl02 ± 8, P < 0.05) and a lower hypertension index (pre 2.45 ± 2.77, cur 1.62 ± 1.70, P<0.05). Although conversion may carry some risk of acute rejection, it improves graft function and the cardiovascular risk profile significantly.

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