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Triple therapy in cadaver renal transplantation
R M Jones1, J A Murie, R D Allen
1Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, UK.
The British Journal of Surgery
|January 1, 1988
Summary
Triple therapy effectively suppresses the immune system in kidney transplant recipients, improving patient survival. However, graft survival rates were lower, highlighting the importance of HLA-DR matching for better long-term outcomes.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation immunology
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Effective immunosuppression is crucial for graft survival, balancing efficacy with side effects.
- Cyclosporin, azathioprine, and prednisolone (triple therapy) is a common immunosuppressive regimen.
Purpose of the Study:
- To evaluate the efficacy and safety of triple therapy in cadaver renal allograft recipients.
- To assess the impact of HLA-DR matching on graft survival.
- To analyze patient and graft survival rates in first-time and regrafted recipients.
Main Methods:
- A cohort of 100 consecutive renal allograft recipients (72 first, 28 regrafted) were studied.
- Patients received immunosuppression with cyclosporin, azathioprine, and prednisolone.
- Follow-up was for a median of 17.3 months, with actuarial survival analysis.
Main Results:
- Actuarial patient survival at 12 and 24 months was 97.7%.
- Actuarial graft survival at 12 and 24 months was 79.5% (81.3% for first grafts, 75% for regrafts).
- HLA-DR matching significantly improved graft survival: 93% at 1 year for compatible vs. 83% and 54% for mismatched kidneys.
Conclusions:
- Triple therapy provides effective immunosuppression with reduced cyclosporin side-effects and no apparent over-immunosuppression.
- HLA-DR matching is a critical factor for enhancing renal allograft survival.
- While acute nephrotoxicity was infrequent, elevated serum creatinine persisted post-transplant.