THE IMPACT OF QUADRUPLE IMMUNOSUPPRESSION WITH OKT3 ON KIDNEY-TRANSPLANTATION IN BLACK RECIPIENTS

BACKGROUND: Black recipients of kidney transplants have been shown to have lower graft survival than other racial groups. There is ongoing c ontroversy about the optimal immunosuppressive protocol for blacks aft er kidney transplantation. PATIENTS AND METHODS: Five hundred-eighty-t wo recipients of kidney transplants performed between 1985 and 1994 we re divided into three groups: (1) nonblacks who received cyclosporine and prednisone (N = 292); (2) blacks who received ''quadruple'' cyclos porine based immunosuppression with OKT3 induction (N = 98); and (3) b lacks who received cyclosporine and prednisone only (N = 192). Patient and graft survival and incidence of acute rejection episodes were com pared among the groups. RESULTS: Blacks had lower graft survival when compared with nonblacks. However, in the subgroup of black recipients who received quadruple immunosuppression, graft survival at 1 year was higher and the incidence of acute rejection episodes was significantl y decreased compared with blacks without induction. Graft survival and the incidence of acute rejection in blacks on quadruple therapy was c omparable with nonblacks. CONCLUSIONS: Our data support the principle that quadruple immunosuppression should be used routinely for black re cipients of kidney transplants.