Evolution of immunosuppression at the University of Minnesota.

Immunosuppressive protocols at the University of Minnesota have evolved from identical immunosuppression for all recipients (prednisone, azathioprine, and antilymphocyte globulin) to differing protocols for living (triple therapy) and cadaver (sequential therapy) donor recipients, and then to our current protocol in which all recipients receive induction therapy with rapid discontinuation of prednisone. At the same time, progress has been made in the prevention and treatment of cytomegalovirus infection along with numerous parallel improvements in patient care, including in anesthesia, dialysis, and intensive care unit care. The net result has been an incremental improvement in recipient and graft survival.