CYCLOSPORINE IN PRIMARY HAPLOIDENTICAL LIVE-DONOR KIDNEY-TRANSPLANTATION - IS IT WORTHWHILE

Two consecutive prospective randomized trials were performed to study three immunosuppressive protocols in 195 kidney transplant recipients. Only adult primary renal transplant recipients with one haplotype HLA mismatch were included. All patients received kidneys from living rel ated donors and had previous donor non-specific blood transfusions. St udy I included 112 recipients who were randomly assigned to receive ei ther azathioprine (Aza) and prednisolone (P) (n=54) or cyclosporin (Cs A) and P (n=58). Patients in this study were followed up for 3 6 years (mean 50+/08 months). Study II included 83 recipients who were random ly assigned to receive either triple therapy of Aza-CsA-P (n=41) or co nventional therapy of Aza-P (n=42). Patients in this study were follow ed up for a period of 32+/-10 (range 26-43) months. Analysis of data i n the two studies demonstrated the absence of statistically significan t differences in graft or patient survival rates over short- and long- term follow-up periods among recipients of the conventional immunother apy and those receiving the CsA-P or the triple therapy. The overall f requency of acute rejection episodes was not significantly different b etween the two treatment groups of each study. Serum creatinine was si gnificantly higher in the CsA P group while the incidence of infection was significantly lower in the triple group. When switching from one regimen to another is considered, at least 75% of the one-haplotype HL A mismatched live-related donor renal transplants could be maintained on conventional immunotherapy with comparable degree of success to tho se treated with the CsA-P or the triple therapy. However, in at least 15% of patients with conventional immunotherapy, CsA could reverse ong oing rejections and can therefore be considered as a rescue treatment.