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Concerns regarding cyclosporine (CSA) nephrotoxicity have led to the adoption of sequential antibody induction regimens with delayed introduction of CSA, particularly in the setting of acute tubular necrosis (ATN) or delayed graft function (DGF). The purpose of this study is to evaluate the effect of race on outcome in cadaver renal transplants treated with full-dose CSA immediately after transplantation, without antibody induction regardless of the presence of graft function. The records of 171 first cadaver renal transplants performed between 1992-96 with a minimum follow-up of 1 year were reviewed (70 Caucasians and 101 African-Americans [AA]). A triple immunosuppression regimen was used and CSA was administered immediately after transplantation in all casts with target levels of 400 ng/ml (whole blood monoclonal). None of the patients received antibody induction regardless of the presence of DGF. ATN was defined as serum creatinine (sCr) >3 mg/dl on day 7 and DGF was defined as the need for dialysis within 7 days of transplant. The two groups were comparable vis-a-vis recipient and donor demographics, preservation time, HLA mismatch, body mass index, % panel reactive antigen and % diabetic
The incidence of biopsy-proven acute rejection was similar in Caucasians and AA (20% vs 25%, P=0.2). 21% of AR episodes were steroid-resistant in Caucasians compared to 24% in AA (P=0 5). In conclusion, the well-described negative effect of AA race on renal graft outcome was not observed in our patient population. Although early graft function was inferior in AA, late function and graft survival at 1 and 5 years were similar in AA and Caucasians. Immediate exposure of the graft to therapeutic levels of CSA may be important for attaining maximal immunologic efficacy. Our findings question the necessity for antibody induction in either race, even in the presence of DGF.