COMPARATIVE ANALYSIS OF THE DST AND IMURAN-PLUSDST PROTOCOLS FOR LIVE DONOR RENAL TRANSPLANTATION1

Abstract

A comparative analysis of 2 consecutive clinical trials was done: the 1st in 56 patients who received blood transfusions from their prospective donors (DST group) and the 2nd in 36 patients who received such transfusions while they were taking Imuran in an attempt to reduce the incidence of sensitization against the donor (IM + DST group). Imuran significantly (P < 0.05) reduced the rate of sensitization from 27 to 11%. Patients who had prolonged dialysis before entering one of these protocols were significantly more likely to become sensitized against their living donors, and had significantly higher sensitization against the leukocyte panel, although panel-reactive antibodies were not significantly changed by transfusions from the live donor. MLC [mixed lymphocyte culture] reactivity against the living donor was not significantly altered by donor transfusions, and was also not different for sensitized and transplanted patients. Results of transplantation were excellent in both patient groups, with only 2 grafts and 2 patients lost in 68 transplants (actuarial 1 yr survival of 97 and 93% of patients alive and with functional grafts at 1 yr in the DST and IM + DST groups, respectively). Rejection episodes occurred in .apprx. 50% of each group, but were of a special type (DST-type rejection) in .apprx. 30% of the DST patients and 10% of the IM + DST patients (P = 0.07). The probability of transplantation, and the results of transplantation after unsuccessful entry into one of these protocols was not adversely affected. Primarily because of the low rate of sensitization the IM + DST protocol is probably superior to the DST protocol. Both are established clinical tools that have increased clinical transplant volume by a large number of highly successful transplants.