To determine whether prolonged reduction of
azathioprine in renal transplant recipients with
chronic hepatitis affected the progression of
liver disease without an adverse effect on graft survival we studied all transplant patients with a raised
serum glutamic oxaloacetic transaminase level greater than normal for more than 1 year who had
azathioprine reduced below 100 mg/day for longer than 1 year. Six
HBsAg-positive patients had
chronic hepatitis for 67 +/- 7 (SE) months before reduction of
azathioprine and were followed for a further 49 +/- 14 months. None of the six patients remitted, 3 patients died from
liver disease, and none returned to dialysis. In the group of 12 patients who did not have
azathioprine reduced, none remitted, 4 died from
liver disease, and none returned to dialysis during a follow-up of 115 +/- 9 months. Seven
HBsAG-negative patients had
chronic hepatitis for 32 +/- 11 months before reduction of
azathioprine and were followed for a further 46 +/- 8 months. One of the seven remitted, none died from
liver disease and one returned to dialysis. In the group of 15 patients who did not have
azathioprine reduced 5 patients remitted, none died from
liver disease, and none returned to dialysis. We conclude that prolonged reduction of
azathioprine does not slow the progression of
liver disease in renal transplant recipients with
HBsAg-positive or
HBsAg-negative
chronic hepatitis, nor does it predispose to graft failure. However reduction of immunosuppression early in the course of
hepatitis B disease may be necessary to prevent adverse long-term sequelae.