Mismatched living, related donor renal transplantation: a prospective, randomized study

A prospective, randomized study of 49 mismatched living, related donor renal transplants was undertaken to compare the effect of donor-specific transfusions (DST) combined with conventional immunosuppressive therapy (azathioprine, prednisone, and antilymphoblast globulin) to cyclosporine and prednisone with and without use of prior DST. The results demonstrated that cyclosporine and prednisone without DST have equal patient and graft survival rates after transplantation and an equal incidence of infectious complications and rejection episodes when compared with recipients who received DST and conventional therapy. Patients who received DST and subsequent cyclosporine had poor graft survival rates with more rejection episodes and infectious complications. Hospitalization and the relative cost of transplantation were decreased when recipients received cyclosporine without prior DST. It is concluded that cyclosporine allows easier access to transplantation, is more cost effective in the initial posttransplant period, and does not subject the recipient to the risk of donor sensitization as is seen with DST recipients given conventional therapy. The nephrotoxic side effects of cyclosporine have been minimal and renal function remains excellent in the recipients treated with cyclosporine.