A FOUR-YEAR EXPERIENCE WITH DONOR BLOOD TRANSFUSION PROTOCOLS FOR LIVING-DONOR RENAL TRANSPLANTATION

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Abstract
Experience over the last 4 yr with HLA-identical, donor-specific transfusion (DST), and Imuran (IM)+DST living-donor transplants in 206 patients is presented. Transplants from 8 completely incompatible sibling donors, 4 distantly related donors, and 7 unrelated donors are included. Except for a slightly higher average serum creatinine, and a markedly reduced rate of donor-specific sensitization in the IM+DST group when compared with the DST group (14% vs. 31%, P < 0.005), the results of transplantation using these 3 protocols have been equivalent. Actuarial 1-yr survival was 97% for patients and 93% for grafts for the combined group of 206 patients. Of the 44 patients who entered the DST or IM+DST protocols but were not transplanted, 32 patients (70%) have subsequently been transplanted, and all 5 recipients of living-donor kidneys and 20 of 26 recipients of cadaveric kidneys (77%) have functioning grafts. Because it optimizes the availability of transplantable living-donor kidneys, gives results equivalent to those obtained with HLA-identical donors and the DST protocol, and is not associated with clinically apparent adverse effects, the IM+DST protocol is now used for all living-donor transplants except those between HLA-indentical donor-recipient pairs.