Azathioprine Monotherapy in HLA-Identical Live Donor Kidney Transplant Recipients

Journal of Transplant Coordination, Vol. 9, Number 1, March 1999 of hypertension,13-15 reduction in serum lipid levels,16-19 correction of posttransplant diabetes mellitus,19 and accelerated growth in children.20,21 Reported benefits of CsA withdrawal have included reduced cost and avoidance of long-term nephrotoxicity.10,11 Hypertension occurs in more than 50% of renal transplant recipients and has been attributed to multiple factors, including the presence of diseased native kidneys, acute and chronic allograft rejection, recurrence of original disease, and transplant renal artery stenosis. Although corticosteroids are known to elevate blood pressure in nontransplant patients, the role of these agents in the pathogenesis of posttransplant hypertension remains controversial. The influence of steroids has been further obscured by the routine use of CsA that also exacerbates posttransplant hypertension. However, studies have shown that cessation of steroids is accompanied by a significant decrease in mean arterial blood pressure and by a reduction in the number of required antihypertensive medications.6 , 7 , 1 2 1 5 Multivariate analysis in one study in which patients were maintained on AZA and CsA after steroid withdrawal showed the reduction in blood pressure was directly related to the prior severity of hypertension and inversely related to the dose of CsA.13 Hypercholesterolemia is common after renal transAzathioprine monotherapy in HLA-identical live donor kidney transplant recipients