IMMUNOSUPPRESSIVE TREATMENT OF PRIMARY CADAVERIC RENAL-TRANSPLANT PATIENTS RECEIVING KIDNEYS FROM NON-HEART-BEATING DONORS

Since November 1982, 276 primary cadaveric kidney transplants have bee n performed using kidneys from non-heart beating donors. Between Novem ber 1982 and December 1986, 49 transplant patients were treated with c yclosporine and steroid immunosuppressive therapy (CSA regimen). Twent y-seven patients were treated with low dose cyclosporine (initial dosa ge, 4 mg/kg/day), steroid therapy, and a 21-day course of 500 mg/day a ntilymphocyte globulin (ALG 1 regimen) between January 1987 and Decemb er 1987. Seventy-nine patients were treated with low dose cyclosporine (initial dosage, 6 mg/kg/day), steroid therapy, and a 14-day course o f 1,000 mg/day antilymphocyte globulin (ALG 2 regimen) between January 1988 and June 1990, and 85 patients were treated with low dose cyclos porine (initial dosage, 6 mg/kg/day), steroid therapy, and a 14-day co urse of 1,000 mg/day antilymphocyte globulin followed by 2 mg/kg/day m izoribine (ALG 3 regimen) between July 1990 and May 1995. Ten patients , who showed hypersensitivity to antilymphocyte globulin therapy, were treated with low dose cyclosporine, steroid therapy, and mizoribine. Finally, 26 patients were treated with FK506 and steroid therapy (FK50 6 regimen) between June 1990 and February 1992. Craft survival was 78% at 1 year, 69% at 3 years, 63% at 5 years, anti 51% at 10 years in th e CSA regimen group and 67% at 1 year, 52% at 3 years, and 48% at 5 ye ars in the ALG I regimen group. It was 85% at 1 year, 70% at 3 years, and 62% at 5 years in the ALG 2 regimen group and 87% at 1 year and 67 % at 3 years in the ALG 3 regimen group. In the FK506 regimen group, g raft survival was 92% at 1 year and 80% at 3-5 years. Never-functionin g grafts were observed in 3 CSA patients (6%), 1 ALG 1 patient (4%), 3 ALG 2 patients (4%), 3 ALG 3 patients (4%), and 1 FK506 patient (4%). These results indicate that low dose cyclosporine (initial dosage, 6 mg/kg/day), steroid therapy, and a 14 day course of antilymphocyte glo bulin therapy is beneficial for cadaveric renal transplant patients re ceiving kidneys from non-heart beating donors; FK506 and steroid thera py might be more effective than cyclosporine based immunosuppressive t herapies even in such patients.