Evolving strategies in immunosuppressive therapy: the Emory experience

We have reviewed our experience with various immunosuppression regimens over the past 11 years in 2,065 renal transplant recipients. Patients received triple-drug maintenance therapy with CsA, imuran and prednisone following either no induction therapy or treatment with polyclonal (PCA) or monoclonal (MCA) antibody. The most recent immunosuppressive regimen has included CsA, MMF, and prednisone without induction therapy. We observed that those patients receiving PCA had a better graft survival 5 years after transplantation than recipients with MCA induction or those receiving standard triple drug therapy without induction. Patients receiving MMF experienced superior one-year graft survival compared with those receiving induction with PCA, MCA or standard triple drug therapy. A similar one-year graft survival rate for both Black and White recipients was observed in the MMF group and raises the possibility of achieving improved long-term graft survival in Black recipients with a MMF-based immunosuppression strategy. Our experience indicates that excellent short-term graft survival can be achieved with an immunosuppressive protocol of MMF, CsA and prednisone without induction. Graft survival in MMF-treated recipients was equal to or superior to that which we previously achieved with induction therapy.