ANTILYMPHOCYTE INDUCTION THERAPY IN CADAVER RENAL TRANSPLANTATION

Abstract

Antilymphocyte induction therapy in cadaver renal transplantation is controversial. The effectiveness of antilymphocyte therapy in the current era of cyclosporine and tacrolimus use has been questioned. The United Network for Organ Sharing data set for the Center-Specific Outcomes Analysis, which has been verified by the transplant centers, was used for this study. At the time information in the database was confirmed, all transplant centers were queried on their use of an antilymphocyte preparation at the time of transplantation, and whether it was used within 24 hr of transplant surgery, the duration of the specific reagent. This allowed us to analyze 24,191 cadaver transplant procedures performed 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 received either Minnesota antilymphocyte globulin for 5 days or more or OKT3 for 7 days or more. The relative risk was 0.82 for Minnesota antilymphocyte globulin and 0.86 for OKT3 (for both, P<0.001). Semiparametric models were then used to compare the effectiveness of the antilymphocyte preparation in both a patient with at least a three-antigen mismatch and patients who had a zero-antigen mismatch. The improvement in graft survival was seen in both match grades. These data demonstrate the improved outcomes with the use of antilymphocyte preparations during the early posttransplant period in the modern cyclosporine era.