Renal transplantation at Hartford Hospital: results of combined and flexible immunosuppression.
1. Three groups of first cadaver kidney transplant recipients at Hartford Hospital were analyzed. All received AZA and P, and most received pretransplant blood transfusions. The first group, 41 patients transplanted from 1977-1979, had a 2 year graft survival of 49%; the second group, 72 patients transplanted from 1980 to 1984 had an emphasis on DR typing and 2-year graft survival of 61%. The third group had the addition of CsA (triple immunosuppression) from 1984 to October, 1988. These 200 patients had a 2-year graft survival of 87%. The 2-year patient survival was 82%, 85%, and 94% for the 3 groups, respectively. 2. Triple immunosuppression resulted in less frequent and less severe rejection activity. There was no increase in serious infection and no significant elevation in mean serum creatinine at a 2-year follow-up, when compared to a control group receiving AZA and P. 3. DST was used selectively for one haplotype living-related donor kidney transplants, and in HLA-identical sibling kidney transplantation. Triple immunosuppression was also used in living-related donor kidney transplants, but in a very low-dose range. Only 3 of 58 grafts in living-related donor kidney transplants have been lost in the past 4 years; none due to rejection. 4. OKT3 therapy has been used primarily for steroid-resistant rejection, usually resulting in reversal, but also in a significant increase in CMV infection. When an "OKT3 available" group of cadaver kidney transplant recipients was compared to a previous control group, OKT3 therapy did not appear to improve the overall results. 5. Patients receiving retransplantation experienced a better success rate than reported at many other centers, (72% graft survival at 2 years). The use of OKT3 or ATG and DR matching contributed to the success. 6. The average ATN rate for all perfused kidneys was 36%; 50% for those preserved longer than 28 hours. Imported kidneys preserved with Euro Collins solution had a 63% ATN rate versus 36% for locally procured kidneys. There was no significant difference in graft survival in patients with or without posttransplant ATN.
Schweizer
R T
RT
Department of Surgery, Hartford Hospital, Connecticut.
Bow
L
L
Roper
L
L
Hull
D
D
Bartus
S A
SA
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D002648:Child; D003237:Connecticut / Q000453:epidemiology; D003524:Cyclosporins / Q000008:administration & dosage; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D015993:Life Tables; D008875:Middle Aged; D009926:Organ Preservation; D011241:Prednisone / Q000008:administration & dosage; D012086:Reoperation; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone