141 CHAPTER 14 Kidney Transplantation in Pittsburgh: Experience and Innovations BERND H. MARKUS, 1 THOMAS R. HAKALA,2 ANDREAS TZAKIS, 1 SANDI MITCHELL, 1 IGNAZIO R. MARINO, 1 ROBERT D. GORDON, 1 RENE J. DUQUESNOY,3 AND THOMAS E. STARZL1 Departments of 1 Surgery, 2 Urology and 3 Pathology University of Pittsburgh Pittsburgh, Pennsylvania The first kidney transplant at the University of Pitts- burgh was performed in 1963. but it was not until 1977 that kidney transplants were done on a regular basis. Since then the University of Pittsburgh has developed into a major transplant center. In 1986 alone 271 kidney transplants, 344 liver, 104 heart, and 15 heartllung transplants were performed at the University Health Center of Pittsburgh. The data presented here are maintained on a newly developed center-oriented computerized transplant data management system. A scoring system for equi- table allocation of kidney transplant organs is an in- tegral part and will be discussed further. MATERIALS AND METHODS From 1977 to the end of May 1987. 1.243 cadaveric kidney transplants. 17 kidney transplants from living re- lated donors. and 16 multiorgan transplants including a kidney were performed at the University Health Center in Pittsburgh. Azathioprine and steroid immunosuppres- sive baseline treatment was routinely used until a ran- domized trial versus combined CsA and steroid treat- ment was performed in early 1981. This was followed by the formal introduction of CsA and steroids as the baseline immunosuppressive treatment. Azathioprine and steroids remained the first choice only for living re- lated kidney transplants. Since November 1984 the murine monoclonal antibody OKT3 (ORTHOCLONE OKT3. ORTHO Pharmaceutical Corporation. Raritan. NJ) has been used for treatment of severe rejection episodes. Statistical analysis was performed using the SPSSPC (SPSS/PC Software Inc .• Chicago, IL) (1) and BMDP/PC (BMDP Software Inc.. Los Angeles. CAl software packages.