ANTILYMPHOCYTE INDUCTION THERAPY IN CADAVER RENAL-TRANSPLANTATION - ARETROSPECTIVE, MULTICENTER UNITED NETWORK FOR ORGAN SHARING STUDY

Antilymphocyte induction therapy in cadaver renal transplantation is c ontroversial. The effectiveness of antilymphocyte therapy in the curre nt era of cyclosporine and tacrolimus use has been questioned. The Uni ted Network for Organ Sharing data set for the Center-Specific Outcome s Analysis, which has been verified by the transplant centers, was use d for this study. At the time information in the database was confirme d, all transplant centers were queried on their use of an antilymphocy te preparation at the time of transplantation, and whether it was used within 24 hr of transplant surgery, the duration of the specific reag ent. This allowed us to analyze 24,191 cadaver transplant procedures p erformed between the October 1, 1987, and the January 31, 1991. Using Cox regression analysis, as well as semiparametric logistic regression models, we demonstrated improved allograft outcomes in patients who r eceived either Minnesota antilymphocyte globulin for 5 days or more or OKT3 for 7 days or more. The relative risk was 0.82 for Minnesota ant ilymphocyte globulin and 0.86 for OKT3 (for both, P<0.001). Semiparame tric models were then used to compare the effectiveness of the antilym phocyte preparation in both a patient with at least a three-antigen mi smatch and patients who had a zero-antigen mismatch. The improvement i n graft survival was seen in both match grades. These data demonstrate the improved outcomes with the use of antilymphocyte preparations dur ing the early posttransplant period in the modern cyclosporine era.