Outcome of cadaveric renal transplantation by induction treatment in the cyclosporine era

Abstract

A total of 358 cadaveric renal transplantations performed between 1984 and 1993 received induction therapy with Minnesota antilymphoblast globulin (MALG) 95, muromonab-CD3 (OKT3) 58, antithymocyte globulin--Upjohn (ATGAM) 104, rabbit antithymocyte serum (RATS) 37, or cyclosporine (CyA) 64. There were no differences in age, gender, HLA mismatches and maintenance immunosuppression between these groups of recipients. A significantly higher proportion of OKT3 induction patients were retransplants (50%, p < 0.0001). There were fewer diabetic recipients in the group that received RATS (8%) compared to the other groups (p = 0.0009). There was no significant difference in overall graft survival with the various forms of induction treatment (log rank test, p = 0.48). Similarly, primary cadaveric graft outcome was not different with various forms of induction treatment (p = 0.62). Acute rejection was higher with ATGAM, occurring in 65% of patients, compared to MALG (52%), OKT3 (55%), RATS (43%) and CyA (55%). A significantly lower number of patients were rejection-free with ATGAM (35%) compared to MALG (48%) (p = 0.04). Patients who received ATGAM induction also had a higher rate of rebound rejection. Patients receiving ATGAM induction had a significantly higher serum creatinine level at 1 and 6 months post-transplantation (p < 0.005) compared to other induction treatments. In conclusion, the prevalence of acute rejection was higher with ATGAM, which was also reflected by higher serum creatinine levels. However, the long-term graft function and survival were not different with the various induction treatments.