ROLE OF PREOPERATIVE DONOR-SPECIFIC TRANSFUSION AND CYCLOSPORINE IN HAPLO-IDENTICAL LIVING-RELATED RENAL-TRANSPLANT RECIPIENTS

A prospective randomized trial of use of donor-specific transfusion an d cyclesporine given 24 h before operation was performed in living rel ated renal transplant recipients. The benefits, disadvantages and effe ct on graft and patient outcome was analyzed. Cyclosporine was started 72 h before operation and 48 h before donor-specific transfusion (DST ). Fifteen patients received DST while another 15 age- and sex-matched living related renal allograft recipients on similar immunosuppressio n served as controls. Patient and donor demographics were similar in t he two groups. The DST group had significantly fewer rejection episode s than the control group (0.26 vs. 1.1 rejection episode per patient, p < 0.01). There were fewer episodes of acute rejection in the first 3 months posttransplant in the DST group. Hyperresponder recipients (as tested by mixed lymphocyte cultures) also benefitted by DST which sig nificantly reduced the number of acute rejection episodes (0.25 vs. 1 episode per hyperresponder patient, DST vs. control, p < 0.05). The ne ed for dialysis, incidence of infections and other complications were similar in the two groups. Graft function at 3, 6, 9 and 12 months aft er transplant was significantly better in the DST group (p < 0.05). Gr aft survival at 1 year in DST group (85.5%) was not statistically diff erent than control (74.8%). In conclusion, DST and cyclosporine given 24 h before live related renal transplantation is effective in improvi ng graft function and reducing the number of acute rejection episodes which could have a beneficial effect on long-term graft survival.