Outcome of cadaveric renal transplantation by induction treatment in the cyclosporine era

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Abstract
A total of 358 cadaveric renal transplantations performed between 1984 and 1993 received induction therapy with Minnesota antilymphoblast globulin (MALG) 95, muromonab‐CD3 (OKT3) 58, antithymocyte globulin ‐ Upjohn (ATGAM) 104, rabbit antithymocyte serum (RATS) 37, or cyclosporine (CyA) 64. There were no differences in age, gender, HLA mismatches and maintenance immunosuppression between these groups of recipients. A significantly higher proportion of OKT3 induction patients were retransplants (50%, p<0.0001). There were fewer diabetic recipients in the group that received RATS (8%) compared to the other groups (p=0.0009). There was no significant difference in overall graft survival with the various forms of induction treatment (log rank test, p=0.48). Similarly, primary cadaveric graft outcome was not different with various forms of induction treatment (p=0.62). Acute rejection was higher with ATGAM, occurring in 65% of patients, compared to MALG (52%), OKT3 (55%), RATS (43%) and CyA (55%). A significantly lower number of patients were rejection‐free with ATGAM (35%) compared to MALG (48%) (p=0.04). Patients who received ATGAM induction also had a higher rate of rebound rejection. Patients receiving ATGAM induction had a significantly higher serum creatinine level at 1 and 6 months post‐transplantation (p<0.005) compared to other induction treatments. In conclusion, the prevalence of acute rejection was higher with ATGAM, which was also reflected by higher serum creatinine levels. However, the long‐term graft function and survival were not different with the various induction treatments.