RICHARD N. FINE, M.D.; PAUL I. TERASAKI, Ph.D.; ROBERT B. ETTENGER, M.D.; GABRIEL DANOVITCH, M.D.; RICHARD M. EHRLICH, M.D.
Various factors affect the outcome of renal transplants in humans. Matching for HLA-A, -B, and -DR histocompatibility antigens improves survival rates for renal allografts from first cadaver donors. Zero-HLA-A- and -B-antigen-mismatched grafts and two-HLA-DR-antigen-matched grafts do better, although results differ depending on the recipient's primary renal disease. Pretransplant third-party blood transfusions significantly improve survival rates of cadaver donor allografts. The mechanism of this beneficial effect has not been identified; however, blood transfusions probably do not "select out" high responders among potential recipients by stimulating the production of lymphocytotoxic antibodies. Cyclosporine has been heralded as a potent, nonspecific immunosuppressive agent that will significantly improve renal allograft survival rates. The selectivity of cyclosporine's effect on T lymphocytes is advantageous; however, its side effects, especially nephrotoxicity, may limit its usefulness. Attention to the potential surgical complications of renal transplantation can significantly reduce morbidity and mortality.
FINE RN, TERASAKI PI, ETTENGER RB, DANOVITCH G, EHRLICH RM. Renal Transplantation Update. Ann Intern Med. 1984;100:246–257. doi: 10.7326/0003-4819-100-2-246
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Published: Ann Intern Med. 1984;100(2):246-257.
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