longterm outcome after switch from cyclosporinebased tripledrug immunosuppression to double therapy at three months cyclosporin a cya together with steroids and azathioprine aza has been successfully used for prophylactic immunosuppression in numerous recipients of kidney allografts the aim of this study was to evaluate the longterm effect of reducing this initial tripledrug therapy to doubledrug therapy at 3 months one hundred consecutive recipients of a cadaveric renal allograft with stable and good graft function were randomly allocated to continue with cya and steroids group 1 or cya and aza group 2 both groups were comparable with regard to all relevant patient characteristics after a mean observation period of 55 2676 months no significant difference was observed in the incidence of acute rejection episodes after conversion 4 in group 1 and 5 in group 2 or in the incidence of graft loss 4 in group 1 and 5 in group 2 all graft rejection episodes were easily reversed with steroid pulses and patients switched back to tripledrug therapy patient survival was 94 in group 1 and 100 in group 2 at 55 months in group 1 however a higher number of viral infections and steroidrelated side effects was noted from these data it is concluded that initial tripledrug therapy can safety be reduced to a cyabased doubledrug combination after 3 months in renal allograft recipients with stable function the combination with aza is recommended because of its fewer side effects