A four-year experience with donor blood transfusion protocols for living-donor renal transplantation.

Our experience over the last 4 years 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 less than .005), the results of transplantation using these 3 protocols have been equivalent. Actuarial one-year 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, 31 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, we now use the IM + DST protocol for all living-donor transplants except those between HLA-identical donor-recipient pairs.