Conventional immunosuppressive therapy in modern renal transplantation

Conventional immunosuppression has been replaced by cyclosporine protocols for renal transplantation in most centers. Some centers have continued using conventional immunosuppression in certain instances. In our series, 104 patients received 105 kidney allografts (58 cadaver, 47 living donor) in 1983 and 1984. No patients was treated with cyclosporine. Patient survival was 95% and 92% at six months and one year, respectively. Eight deaths were caused by sudden cardiorespiratory events (four), liver failure (one), and suicide (one); fatal infection occurred after regrafting in two asplenic patients. Actuarial graft functional survival was 80% at 12 months; living related donor graft survival of 94% at one year was comparatively better than the 66% with cadaveric grafts. Death from excessive pharmacologic immunosuppression did not occur. Graft survival was excellent with living donor and acceptable with cadaveric grafts, especially with good tissue matching. Conventional immunosuppression may remain applicable in renal transplantation under conditions of low risk for graft loss.