Management of the renal allograft recipient: Immunosuppressive protocols for long‐term success

To determine the benefits of long‐term cyclosporine (CsA) immunosuppression, renal allograft recipients were randomly assigned to a protocol of either: CsA + azathioprine (Aza) +prednisone (TD), or to a protocol in which CsA was discontinued from the regimen of Aza + prednisone (CsA D/C). With a mean follow‐up of nearly 7 years since transplantation, 30/47 (64%) CsA D/C and 27/45 (60%) TD had functionign allografts. Although long‐term survivals were similar, hazards of the CsA D/C protocol were evident (40% rate of acute rejection following CsA D/C). Conversely, continued CsA in the TD protocol provided the opportunity for prednisone reduction, or even complete prednisone withdrawal in selected patients. A TD protocol which can provide equivalent long‐term success, and eventually lower or omit prednisone, is preferable to a protocol of CsA D/C.