IMPACT OF IMPROVING IMMUNOSUPPRESSIVE TREATMENT ON OUTCOME IN CADAVERIC KIDNEY-TRANSPLANTATION

Background. Since the advent of cyclosporine-based immunosuppression f or cadaveric kidney transplants in 1983, several changes have been mad e in immunosuppressive management at the University of Wisconsin. Sinc e 1986, OKT3 has been available to treat steroid-resistant rejection; since 1992, OKT3 has been used as an induction agent replacing antilym phocyte globulin; and since 1993, mycophenolate mofetil has been used in 104 patients. Methods. The impact of different immunosuppressive st rategies on overall and immunologic graft survival (defined as graft l oss caused by rejection) was evaluated in 1210 primary cadaveric renal transplants at the University of Wisconsin. Covariables, including de gree of human leukocyte antigen matching, age, gender, cause of kidney failure, and early graft dysfunction, were evaluated. The series was subdivided into four eras according to immunosuppressive regimen, and the results were analyzed by era. Results. Our principal findings are that immunologic graft survival has improved significantly during this series whereas overall graft survival has not. Mycophenolate was asso ciated with a significant decrease in acute rejection. For a given pat ient, graft loss from rejection becomes less likely over time. Late re jection poses a greater risk than early rejection for graft loss. Conc lusions. Improving outcomes may be related to improving immunosuppress ive treatment,increasing degree of human leukocyte antigen matching, a nd better early graft function.