Living-donor renal transplantation in SEOPF. The impact of histocompatibility, transfusions, and cyclosporine on outcome.

The impact of haplotype match (HM), pretransplant transfusions, and cyclosporine use were examined for living-donor renal transplants performed among 49 centers in the South-Eastern Organ Procurement Foundation (SEOPF) from November 1983 to June 1988 with follow-up through March 1989. During this period, 750 2-HM, 1246 1-HM, and 120 0-HM living-donor transplants were performed at 46, 47, and 27 centers, respectively. Demographic comparisons of the HM categories demonstrated the greatest use of cyclosporine and donor-specific transfusions in the 0-HM group, and the greatest use of random blood transfusions (RBT) or no blood transfusions (NBT) in the 2-HM group. By univariate and multivariate (Cox regression) analyses, actuarial graft survival was significantly associated with haplotype match, although excellent 3-year graft survival was seen for 0-HM as well as 1-HM and 2-HM first transplant recipients: 74 +/- 5%, 80 +/- 2%, and 85 +/- 2%, respectively. Comparisons were also made among patients receiving DST +/- CsA, RBT +/- CsA, and NBT +/- CsA for each HM group by univariate and multivariate analyses. For 0-HM recipients, DST + CsA was most frequently used and associated with the best long-term survival (86 +/- 5% at 3 years) by univariate analysis. For 1-HM recipients, there were no apparent differences in graft survival between DST and RBT groups +/- CsA by univariate analysis, but the absence of transfusion (NBT +/- CsA) was associated with the poorest 3-year survival (79 +/- 4%). This was confirmed by multivariate analysis, where DST (P less than 0.06) and RBT (P less than 0.02) were each significantly associated with graft survival, and provided relative benefits (vs. NBT) of 0.56 and 0.44, respectively; CsA use was not significantly associated with outcome or a significant benefit. For 2-HM recipients, the poorest results were seen with DST + CsA (78 +/- 6% at 3 years) by univariate analysis; multivariate analysis suggested no benefit with DST or RBT, and an increased risk of graft loss with CsA. These results indicate that the use of pretransplant transfusions and CsA therapy may have differential benefits depending upon HM in living-donor renal transplantation.