A multifactorial analysis of 100 consecutive first cadaver kidney transplants was done to document the current status of this treatment for end stage renal disease and to determine the influence of the following variables on kidney losses owing to rejection: splenectomy, pre-transplant transfusions, transfusion at the transplantation, recipient sex, pre-transplant nephrectomy, donor and recipient A, B or O blood group, human leukocyte A and B antigen mismatches, kidney preservation method, donor treatment with methylprednisolone and cyclophosphamide, recipient treatment with antilymphocyte serum or antilymphoblast globulin and a low dose of steroid treatment for rejection. Pretransplant splenectomy for leukopenia, 5 or more pre-transplant blood transfusions and pre-transplant transfusions without development of circulating cytotoxic antibodies significantly reduced kidney losses owing to rejection (p less than 0.05). A low dose of steroid treatment for rejection resulted in a trend towards improved patient survival without sacrificing kidney graft survival. Clinical studies demonstrating decreases in kidney graft rejection should be controlled for pretransplant blood transfusions and, possibly, for pre-transplant splenectomy for hypersplenism.
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