Recipient lymphocyte sensitivity to methylprednisolone affects cadaver kidney graft survival

In 42 recipients of mixed-lymphocyte-culture (MLC) incompatible cadaver kidneys and conventional immunosuppressive treatment (azathioprine and steroids) the concentrations of methylprednisolone suppressing the in-vitro response of pretransplant lymphocytes to phytohaemagglutinin by 50% (ED50) were determined. 1-year graft survival was significantly higher in 21 recipients with methylprednisolone ED50 values below the median than in 21 patients with higher than median ED50s (86% v 29%; p less than 0.0002). Thus, the steroid sensitivity of recipients strongly influences the survival of MLC-mismatched kidneys. In 42 transplant recipients treated with cyclosporin and steroids, the effect of steroid sensitivity was also apparent (1-year graft survival 76% and 57% for recipients with low and high ED50, respectively), though not significant. Determination of the sensitivity to steroids may be valuable in determining which recipients can be given HLA-DR-mismatched kidneys and may serve as a guideline for determining the dose of steroids to be used.