We ptospectively evaluated a quadruple immunosuppressive regimen consisting of Rapa, low dose CsA, low dose MMF and Prednisone (Group I), vs. a triple regimen of CsA, MMF and Prednisone (Group II). Group I included 16 transplant recipients of mismatched LRD and LUD, treated with Rapa (4mg first day postop then 2mg daily), low dose MMF (250-500mg bid starting second day postop), CsA (6-10mg/Kg/day), and Prednisone. Group II included 52 transplant recipients (25 LRD and 27 LUD) and 1 CAD transplant, treated with MMF (1mg bid), CsA (8-12mg/Kg/day), and Prednisone. All patients in Group I received single bolus ATG (4-6mg/Kg). In Group II patients received either single ATG or extended ATG course (3-5 days postop).
Acute rejection occured in 1 patient in Group I (6.3%) that reversed easily with IV methylprednisolone and in 5 (9.4%) in Group II, all of which resulted in graft loss. There was no graft loss or mortality in GroupI, while one patient in GroupII died of septicemia. The quadruple immunosuppressive protocol Rapa/CsA/MMF/Prednisone with single bolus induction ATG achieves excellent immunosuppression and graft survival, with no apparent risks in the short and intermediate term.