DELAYED-HYPERSENSITIVITY SKIN-TESTS AND SUBSEQUENT RENAL-TRANSPLANT OUTCOME

Background Some studies in the literature have supported, while others have denied, the relationship between results of delayed hypersensiti vity skin tests (DHST), renal allograft and patient survival rates. Se veral factors contribute to the unreliability of these studies. For ex ample, most of these studies were performed in the precyclosporine era , furthermore, other variables which influence renal allografts and pa tient survival rates were not controlled in those studies. Objective T he purpose of this study was to investigate the relationship between r esults of DHST performed in the pretransplant period with the subseque nt renal transplant outcome in the cyclosporine era. Methods The study included 103 first cadaveric renal transplant recipients. DHST were p erformed during pretransplant evaluation by intradermal injections of a battery of recall antigens. Based on skin-test results, the patients were assigned to two groups - those with a positive skin test (STP+) and those with a negative (anergic) skin test. These two groups were c ompared with each other regarding allograft survival, patient survival , and other variables known to influence survival rates. Results The m ean age, sex and racial distribution, degree of HLA matches between re cipients and donors, number of acute rejection episodes, and number of patients with acute tubular necrosis were similar between the two gro ups. Renal allograft survival rates in the anergic group at 6 months, 1 year, 2 years, and 3 years were 97%, 90% 84%, and 57%, respectively. The survival rate for renal allografts in the STP+ group for the same time points was 90%, 86%, 80%, and 72%, respectively. Patient surviva l rates for the anergic group at 6 months, 1 year, 2 years, and 3 year s were 95%, 94%, 89%, and 85%, respectively, while those for the STPgroup were 98%, 98%, 98%, and 97% respectively. Differences between th e STP+ and anergic groups, with regard to patient and allograft surviv al rates, were not significant. Conclusion We conclude that DHST is no t helpful in predicting outcome of patient or renal allograft survival rates over a 3-year time period.