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Living related donor kidney grafts in the cyclosporine era
A S MacDonald1, P Belitsky, H Bitter-Suermann
1Transplant Service, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Cyclosporine (CyA) did not improve kidney graft survival in HLA identical recipients compared to azathioprine (AZA), despite reducing rejection. However, CyA did enhance outcomes for haploidentical kidney transplants.
Area of Science:
- Nephrology
- Transplantation Immunology
- Immunosuppression
Background:
- Analysis of 120 living-related donor (LRD) kidney grafts from 1981-1987 during the Cyclosporine (CyA) era.
- Comparison between HLA identical and haploidentical kidney transplant recipients.
Purpose of the Study:
- To evaluate the impact of CyA on kidney graft survival and function.
- To compare CyA efficacy in HLA identical versus haploidentical recipients.
Main Methods:
- Retrospective analysis of 120 LRD kidney transplants.
- Categorization into 49 HLA identical and 71 haploidentical recipients.
- Comparison of outcomes with CyA versus historical azathioprine (AZA) data.
Main Results:
- CyA did not improve short- or long-term graft survival in HLA identical recipients compared to AZA.
- HLA identical recipients on CyA experienced worse kidney function and increased need for antihypertensives.
- CyA demonstrated improved outcomes in haploidentical recipients compared to historical controls.
- Prior sensitization remained a significant risk factor in haploidentical recipients.
Conclusions:
- Cyclosporine offers limited benefit for HLA identical kidney graft survival but may worsen kidney function.
- Cyclosporine shows improved efficacy in haploidentical kidney transplantation, though sensitization is a concern.
Abstract:
The results of 120 LRD kidney grafts, 49 HLA identical and 71 haploidentical, performed between 1981 and 1987 during the CyA era have been analyzed. The reduction in the incidence of rejection in diploidenticals with CyA vs AZA did not increase short- or long-term graft survival but was accompanied by worse kidney function and a greater need for antihypertensives. CyA did improve the results in haploidentical recipients over our historical experience, although prior sensitization was still a major hazard in this group.