A group of 123 patients who had functioning renal transplants for more than 5 years were studied to discover whether prolonged reduction of
azathioprine could predispose to late allograft failure. From the point of entry into the study (5 years after
transplantation), the 5-year cumulative graft survival among living-related-donor recipients was 91.7%, and among non-living-related-donor recipients it was 84.8%. The
azathioprine dose was reduced in 21 patients, for medical reasons, below 100 mg/day for more than one year when serum
creatinine was stable and less than 2 mg/dl. Eight patients subsequently required dialysis. In the control group of 35 patients (transplanted in the same years, with serum
creatinine that was similar at the same time posttransplantation to that of those who had
azathioprine reduced) only 1 patient required dialysis. The likelihood of dialysis was significantly greater in those who had
azathioprine reduced compared with those who did not (chi 2 = 12.0, P less than 0.001). No patient who had
azathioprine reduced because of low white cell counts or
chronic hepatitis subsequently required dialysis. It was concluded that a prolonged reduction of the
azathioprine dose may predispose to late allograft failure.