The quality of initial function following renal transplantation determined by creatinine elimination kinetics. Comparison of Minnesota antilymphocyte globulin and cyclosporine induction immunosuppression.
To compare the effect of type of induction immunosuppression on the quality of initial renal allograft function, we identified 35 cadaver donor kidney pairs in which one recipient of a kidney from a given pair received induction immunosuppression with Minnesota antilymphocyte globulin (MALG group) while the recipient of the contra-lateral kidney received cyclosporine from day zero (CsA group). In the absence of an existing quantitative measure to assess and compare the status of those grafts that function primarily, we defined the half-life of creatinine elimination (t1/2SCr) as such an outcome measure based on a review of creatinine elimination kinetics. All organs were procured with in-situ perfusion and en-bloc removal. Total cold storage times, rewarm times, and perioperative management were comparable for the two groups. In the MALG group, the mean t1/2SCr) was not different from that in the CsA group (1.38 +/- 0.96 days vs 1.35 +/- 1.2 days P = NS). Multiple regression analysis performed on the differences in recipient age, number of DR-B locus matches, total cold ischemia time, rewarm time, and central venous pressure at reperfusion of a given donor pair demonstrated no significant impact of any of these differences on the difference in t1/2SCr for the same pair set in this sample. The nadir of serum creatinine achieved in the first five days posttransplant was somewhat higher in the CsA group (234 +/- 131 mumol/L) as compared with the MALG group (200 +/- 132 mumol/L) but the difference was not significant. A similar nonsignificant trend was observed in the comparison of mean serum creatinine values at 30 days posttransplant (MALG group: 158 +/- 62 mumol/L vs. CsA group: 200 +/- 141 mumol/L). Only one of seventy recipients (CsA group) was dialyzed within the first 5 days posttransplant for an overall incidence of ATN of less than 2%. Fourteen of 35 (40%) recipients in both groups received treatment for acute rejection. The mean time to first treatment for acute rejection episode was shorter in the CsA group than the MALG group (10 +/- 8 days vs 23 +/- 24 days, P = 0.055). Graft survival at one year was not different for the two groups (92% vs. 87% for the MALG and CsA groups respectively, P = NS).(ABSTRACT TRUNCATED AT 400 WORDS)
Shackleton
C R
CR
Department of Surgery, University of British Columbia, Vancouver, Canada.
Keown
P A
PA
McLoughlin
M G
MG
Scudamore
C H
CH
Schechter
M T
MT
Cameron
E C
EC
Yeung
C K
CK
Kane
L M
LM
Manson
A D
AD
Landsberg
D N
DN
D000961:Antilymphocyte Serum / Q000502:physiology; D003404:Creatinine / Q000097:blood* / Q000378:metabolism; D016572:Cyclosporine / Q000494:pharmacology; D006084:Graft Rejection / Q000187:drug effects / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects; D006207:Half-Life; D006801:Humans; D007108:Immune Tolerance; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D007700:Kinetics
D000961:Antilymphocyte Serum; D016572:Cyclosporine; D003404:Creatinine