Renal transplants from HLA-haploidentical living-related donors. The influence of donor-specific transfusions and different immunosuppressive regimens.

A total of 151 potential recipients of kidney grafts from one-HLA-haplotype-mismatched MLC-positive (RR greater than 20%) donors treated during 1980-1984 was investigated. The recipients were divided retrospectively into four groups: (A) 42 patients who received pretransplant donor-specific transfusions (DST) and posttransplant azathioprine/prednisolone (DST-only); (B) 10 patients who received DST with azathioprine before and azathioprine/prednisolone after grafting (DST-aza); (C) 42 patients who received no pretreatment and azathiprione/prednisolone posttransplant (aza group) and (D) 57 patients who also received no pretreatment but cyclosporine/prednisolone posttransplant (CsA group). DST-only led to persistently positive crossmatch in nine (21%) and transient positive crossmatch in two patients, while no sensitization occurred in the DST-aza group. Posttransplant, early acute rejection episodes were frequent in the DST-only group, but no graft was lost to acute rejection during first year; one-year graft survival (GS) = 94%. Similar GS (93%) was obtained in the CsA group, while in the aza group poorer results were obtained; GS = 69%. In the DST-aza group clinical problems including serious infections were observed. As CsA treatment without DST gave as high graft survival as in the DST groups, but avoided the sensitization risk by DST alone and the bone marrow complications of DST-aza, such treatment has become our preferred therapy for haploidentical renal transplants.