Quadruple-drug immunosuppressive induction treatments for immunological high-risk patients in cadaveric renal transplantation using poly and monoclonal antibodies

Abstract

The rates for graft survival in cadaveric renal transplantation became much better after the introduction of cyclosporine (CsA) into clinical immunosuppression. Although 1-year graft survival rates rose about 15% (1) with CsA as the main-immunosuppresant compared to azathioprine-immunosuppressed allograft-recipients, the same observation could not be made for immunological high-risk allograft-recipients. In our clinic these patients remained, even under CsA and triple drug immunosuppressive induction treatment, the group with poor and unsatisfying results. Therefore in 1985 we decided to apply an immunosuppressive induction treatment consisting of four drugs to those patients. In addition to the three ‘traditional’ drugs (CsA, azathioprine, steroids), we first applied one of the commercially available polyclonal antibodies during the first post-transplant week. Our intention was to reduce the capacity of immune response as early as possible after the patient had received his allograft. We expected from this potent immunosuppression in the very early phase after transplantation, a reduction of the frequency of untreatable rejection crises at no higher risk from dangerous infections. Later we used also monoclonal antibodies for this kind of immunosuppressive induction therapy. In 1986 we also started to give quadruple drug immunosuppressive induction in immunological non-risk patients, whose grafts were found to be initially non-functioning kidneys (Gr. 6).