Long-term graft survival with or without donor-specific transfusion in cyclosporine era in one haplo-identical living-related renal transplant recipients beyond the first year: a 19-year experience.

With improvement in immunosuppressive drugs, the beneficial role of donor-specific blood transfusion (DST) in the preconditioning of renal allograft recipients has been diminished. This retrospective study was conducted to investigate the influence of DST on long-term graft survival in successful one haplotype-mismatched kidney transplantation in the cyclosporine (CsA) era at Iwate Medical University. Between August 1983 and October 1996, 52 one haplotype-mismatched living related first renal transplants were performed. Fifty grafts survived beyond the first year after transplantation. These 50 patients were divided into two groups according to maintenance immunosuppression, 12 kidney graft recipients received azathioprine (AZA), prednisolone (PSL), CsA, and DST, and 38 recipients received AZA, PSL and CsA. Our DST protocol consisted of three transfusions of 30 ml of donor-specific buffy-coat at 4-week intervals, without immunosuppressive coverage. In recipients receiving DST and CsA, the 5-, 10-, and 13-year graft survival rates were 100%, 83%, and 67%, respectively. In recipients without DST, the 5-, 10-, and 13-year graft survival rates were 95%, 74%, and 69%, respectively. There was no significant difference between the two groups in long-term graft survival. In conclusion, DST and CsA combination treatment in our protocol may not induce long standing donor-specific immunologic hyporesponsiveness. Other strategies are expected to induce immunotolerance.