title: Prophylactic deoxyspergualin treatment in living-related renal-transplant recipients transfused with donor-specific blood.
abstract: BACKGROUND
  Deoxyspergualin (DSG) prophylaxis has improved long-term graft survival in living-related renal-transplant recipients transfused with donor-specific blood (DST). We examined the influence of acute rejection (AR) on graft survival in these patients.
  
  
  METHODS
  The study groups consisted of either historic control recipients without DSG (group A, n=64, 1985-1989) and recipients with DSG as the initial immunosuppressive agent (group B, n=76, 1989-1995). Both groups received DST from a one-haplotype identical donor and were treated with cyclosporine-based immunosuppression. Rejection was classified into accelerated rejection (Acc, within 5 days), AR (from 6 days-3 months), and late AR (LAR, from 4 months-1 year).
  
  
  RESULTS
  Overall 5-year graft survival rates were significantly higher in group B than group A (89.5 vs. 73.4%, P=0.0070). Each group was then subdivided on the basis of whether or not they had an episode of Acc, AR, or LAR. In group A, 5-year graft survival rate was not affected the presence or absence of Acc (75.0 vs. 73.1%), and it was influenced significantly by the presence or absence of AR (50.0 vs. 85.7%, P=0.0012) or LAR (46.7 vs. 81.6%, P<0.0001). In group B, 5-year graft survival did not change significantly by the presence or absence of Acc (100 vs. 88.7%), AR (81.8 vs. 92.6%), or LAR (81.0 vs. 92.7%).
  
  
  CONCLUSIONS
  Prophylactic use of DSG in living-related renal-transplant recipients treated with DST improves long-term graft survival, even in patients with AR episodes.
authors.affiliation: Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Amada
authors.forename: Hajime
authors.initials: H
authors.lastname: Okazaki
authors.forename: Takaomi
authors.initials: T
authors.lastname: Sato
authors.forename: Shunji
authors.initials: S
authors.lastname: Miura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000187:drug effects; D006146:Guanidines / Q000627:therapeutic use*; D006684:HLA-DR Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged
chemical_list: D006146:Guanidines; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; C037258:gusperimus