Prophylactic deoxyspergualin treatment in living-related renal-transplant recipients transfused with donor-specific blood

Background. Deoxyspergualin (DSG) prophylaxis has improved long-term graft survival in living-related renal-transplant recipients transfused with donor-specific blood (DST). We examined the influence of acute rejection (AR) on graft survival in these patients. Methods. The study groups consisted of either historic control recipients without DSG (group A, n=64, 1985-1989) and recipients with DSG as the initial immunosuppressive agent (group B, n=76, 1989-1995). Both groups received DST from a one-haplotype identical donor and were treated with cyclosporine-based immunosuppression. Rejection was classified into accelerated rejection (Acc, within 5 days), AR (from 6 days-3 months), and late AR (LAR, from 4 months-1 year). Results. Overall 5-year graft survival rates were significantly higher in group B than group A (89.5 vs. 73.4%, P=0.0070). Each group was then subdivided on the basis of whether or not they had an episode of Acc, AR, or LAR. In group A, 5-year graft survival rate was not affected the presence or absence of Acc (75.0 vs. 73.1%), and it was influenced significantly by the presence or absence of AR (50.0 vs. 85.7%, P=0.0012) or LAR (46.7 vs. 81.6%, P<0.0001). In group B, 5-year graft survival did not change significantly by the presence or absence of Acc (100 vs. 88.7%), AR (81.8 vs. 92.6%), or LAR (81.0 vs. 92.7%). Conclusions. Prophylactic use of DSG in living-related renal-transplant recipients treated with DST improves long-term graft survival, even in patients with AR episodes.