title: Role of preoperative donor-specific transfusion and cyclosporine in haplo-identical living related renal transplant recipients.
abstract: A prospective randomized trial of use of donor-specific transfusion and cyclosporine given 24 h before operation was performed in living related renal transplant recipients. The benefits, disadvantages and effect on graft and patient outcome was analyzed. Cyclosporine was started 72 h before operation and 48 h before donor-specific transfusion (DST). Fifteen patients received DST while another 15 age- and sex-matched living related renal allograft recipients on similar immunosuppression served as controls. Patient and donor demographics were similar in the two groups. The DST group had significantly fewer rejection episodes than the control group (0.26 vs. 1.1 rejection episode per patient, p < 0.01). There were fewer episodes of acute rejection in the first 3 months posttransplant in the DST group. Hyperresponder recipients (as tested by mixed lymphocyte cultures) also benefitted by DST which significantly reduced the number of acute rejection episodes (0.25 vs. 1 episode per hyperresponder patient, DST vs. control, p < 0.05). The need for dialysis, incidence of infections and other complications were similar in the two groups. Graft function at 3, 6, 9 and 12 months after transplant was significantly better in the DST group (p < 0.05). Graft survival at 1 year in DST group (85.5%) was not statistically different than control (74.8%). In conclusion, DST and cyclosporine given 24 h before live related renal transplantation is effective in improving graft function and reducing the number of acute rejection episodes which could have a beneficial effect on long-term graft survival.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Sharma
authors.forename: P K
authors.initials: PK
authors.lastname: Rai
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: V
authors.initials: V
authors.lastname: Kher
authors.forename: S
authors.initials: S
authors.lastname: Agrawal
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000208:Acute Disease; D000328:Adult; D001782:Blood Donors; D001803:Blood Transfusion; D016572:Cyclosporine / Q000627:therapeutic use*; D003602:Cytotoxicity, Immunologic / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000503:physiopathology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology*; D006680:HLA Antigens / Q000276:immunology; D006239:Haplotypes; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine