PubMed Health⌕ Search

Biomedical subjects

J M Cecka

Publications and source records attributed to J M Cecka.

At least 91 records · Page 5Linked to original sources
PubMed1993

Six-antigen-matched transplants. Causes of failure.

The causes of failure were studied for 1386 cadaver kidney transplants shared through the UNOS 6-antigen match program from November 1987 to February 1992. The one-year graft survival for 1004 HLA-matched first cadaver transplants was 88% compared with 90% for parent donor and 78% for 22,188 HLA-mismatched first cadaveric donors reported to the UNOS Scientific Renal Transplant Registry. The cause of graft loss was immunological in 55% of HLA-mismatched cadaver kidney failures, whereas only 39% of the HLA-matched graft failures were immunological. The fraction of immunological failures in HLA-matched first transplant recipients younger than age 17 was 57% and decreased with increasing age to 14% for recipients older than age 60. Death with a functioning graft accounted for 50% of failures in the older age group. Sensitization was associated with an increased incidence of immunological failures in matched first graft recipients from 36% in nonsensitized to 53% in broadly sensitized patients, and 55% of failures were immunological in second graft recipients compared with 39% in first transplants. Some immunological failures may have been due to tissue typing, since only 18% of failures in kidneys with well-defined HLA antigens were immunological, whereas 44% of kidneys matched with more difficult HLA antigens were lost due to immunological causes. The results indicate that phenotypically identical cadaver renal transplants have a reduced rate of immunological failures. As the accuracy of this tissue typing for the more difficult HLA antigens improves, immunological failures in this group of transplants will decline even further.

Adolescent↗
PubMed1993

The UNOS Scientific Renal Transplant Registry.

1. The one-, 3-, and projected 10-year graft survival rates for the 35,741 first cadaveric transplants reported to the UNOS Registry were 81%, 69%, and 40%, respectively. The corresponding results of transplantations from parent donors were 90%, 81%, and 54%, and from HLA-identical siblings, 95%, 90%, and 74%. 2. Graft survival rates have improved significantly since the Registry began collecting data in October 1987. Between 1988 and 1991, survival of first-cadaver transplants rose from 77% to 84% (p < 0.001), while that of second transplants increased from 69% to 80% (p < 0.001). Some of the increase in graft survival rates was attributed to a 4-5% improvement in patient survival over the same interval. 3. Graft survival also improved among recipients of living-donor transplants. Overall survival increased from 88% in 1988 to 93% in 1991 (p < 0.003), although the results for 1992 suggest 92% may be a better expectation. The approximately 4% rise was distributed among recipients from each of the major donor relationships: HLA-identical siblings (3%); one-haplotype-matched siblings (8%); and parents (4%). Patient survival improved by one to 3%. 4. Transplants between spouses and those between distant relatives or other unrelated donors yielded excellent results. Graft survival rates at one and 3 years for 284 spousal-donor transplants were 92% and 85%, respectively. The corresponding results for 533 patients transplanted from distant relatives or other living donors were 91% and 84%. In each case, the results were higher than those for transplants from parents to their children (though the difference was not statistically significant). 5. Antilymphocyte antibodies (ALG/ATG/OKT3) given prophylactically resulted in up to a 4% improvement in graft survival rates for recipients of first-cadaver transplants. Patients who received a kidney mismatched at one or 2 HLA antigens had a 2-10% higher graft survival rate each year than those mismatched at 5 or 6 antigens. 6. HLA matching resulted in higher graft survival rates for Whites, Blacks, and Asians. Among Whites, where there was a large number of well-matched transplants, 3-year graft survival was 84% with no mismatches, and 75%, 71%, and 67%, with one or 2, 3 or 4, and 5 or 6 mismatches, respectively. Each decrease in 3-year survival was significant (p < 0.001). Among Blacks and Asians, the rankings showed a similar trend although the number of well-matched patients was small in each race.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1993

Cadaver-donor renal retransplants.

1. There was a dramatic improvement in survival rates for retransplanted patients between 1989 and 1991. The proportion of cadaveric kidneys used to retransplant patients has decreased from 18.4% in 1984 to 14.3% in 1992. In 1992, the 81% one-year survival rate for second transplants nearly reached that of first transplants. 2. Despite recent improvements in regraft survival, the PGST remained the strongest predictor of second graft outcome. One-year regraft survival rates were 54% when the PGST was one to 3 months and 75% when the PGST was more than one year. The steady improvement in second graft survival rates may be influenced by retransplanting more patients with a longer PGST. 3. Patients with broadly reactive anti-HLA antibodies (PRA > 50%) had 10% lower regraft survival rates than nonsensitized patients (p < 0.001). 4. A repeated HLA-DR antigen mismatch resulted in 6% and 13% lower regraft survival at one and 3 years, respectively, compared with patients who had at least one HLA-DR mismatch, but not for the same antigen mismatched previously (p < 0.05). 5. Recipients expressing HLA-DR1 had an 81% one-year second graft survival rate compared with 75% for patients lacking DR1 (p < 0.001). 6. Matching for HLA-B,DR and HLA-A,B,DR antigen combinations resulted in 80-82% one-year regraft survival rates for second and multiple transplant recipients, compared with 57-74% for completely mismatched transplants. 7. Transplants from donors under age 6 or over age 55 had significantly poorer outcomes than those involving kidneys from donors in the intermediate age range. The results of transplants at the extremes of donor age were very poor when the recipient was retransplanted. 8. Among recipients of second and multiple transplants, prophylactic OKT3 yielded 82% and 72% one-year regraft survival, respectively, compared with 75% and 66% with no antibody induction (p < 0.001 for second transplants). 9. Regraft survival rates comparable with those for primary cadaveric transplants reported to the UNOS Registry since 1991 justify the use of cadaver-donor kidneys for low-risk patients seeking second renal transplants.

Adolescent↗
PubMed1993

Effect of HLA matching on renal transplant survival.

1. HLA matching had a significant impact on cadaveric renal allograft survival. The difference in graft survival rates between the best- and worst-matched recipients among the 30,139 first cadaver transplants was 11% at one year, 19% at 3 years, and a projected 32% at 10 years posttransplant (p < 001). 2. Kidneys with no HLA antigens mismatched to the recipient yielded a superior result compared with any other match level. The one- and 3-year graft survival rates were 89% and 83% at one and 3 years, respectively. Even a single HLA antigen mismatch resulted in substantially poorer survival rates of 84% and 72% at one and 3 years (p < 0.001, each comparison). Nevertheless, there was a stepwise decline in graft survival with increasing numbers of mismatched HLA antigens. 3. The number of HLA-matched first cadaver transplants performed has increased from 2% of the total in 1987 to 6% in 1992, as a result of the national 6-antigen-match sharing program instituted by UNOS in 1987 and expanded to include phenotypically matched kidneys in 1990. 4. The incidence of early graft rejection episodes correlated with the number of HLA antigens mismatched. Only 12% of the zero-mismatched recipients experienced early rejection, whereas 26% of those with 5 or 6 antigens mismatched had rejection episodes during the transplant hospitalization (p < 0.01). 5. Transplants performed at the top 20 United States centers (based upon multivariate ranking) showed a strong effect of HLA matching, especially with respect to long-term outcome. The survival difference between the best- and worst-match groups was 9% at one year, 16% at 3 years, and a projected 25% at 10 years (p < 0.05). 6. Similarly, the survival difference between the best- and worst-matched groups at the bottom 20 centers was 16% at one year, 22% at 3 years, and a projected 36% at 10 years (p < 0.01). The bottom 20 centers apparently placed more emphasis on matching. Transplants with fewer than 3 mismatched antigens accounted for 34% of first cadaver transplants in the bottom 20, compared with 26% at the top 20 centers. 7. When all 27 possible HLA-A,B,DR mismatch combinations were examined, those involving HLA-DR mismatches had a strong influence on graft outcome at 3 months, whereas those involving HLA-B mismatches had the most influence on long-term outcome. HLA-A-locus mismatches had the smallest effect on graft outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Graft Rejection↗
PubMed1993

Thirty-year trends in clinical kidney transplantation.

Trends in one-year graft survival rates seen in the past 30 years were examined in the UCLA and UNOS Registries. Some of the trends noted were as follows: 1. One-year graft survival rates for cadaver-donor transplants improved from 40% to 80% during this 30-year period. One-year patient survival improved from 50% to 95%. Transplants from living-related donors improved in graft survival from 80% to 90-95%. 2. Factors that diminished in importance were: recipient race, sensitization, primary disease, HLA haplotype matching in living donors, recipient and donor sex, kidney sharing, and transfusions. 3. Factors that continue to provide about a 10% variation of one-year graft survival are: cold ischemia time, HLA mismatch, recipient and donor age. 4. Posttransplantation, factors such as first-day diuresis, one-week dialysis, rejection at discharge, and discharge serum creatinine continue to be very important determinants of future outcome in 6 yearly subsets of patients. 5. Induction by ALG and OKT3 was shown in 6 subsets to have no effect on one-year graft survival. 6. Future trend studies will be needed to examine the 5-year long-term effects.

Adolescent↗
PubMed1992

Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.

BACKGROUND: The importance of HLA histocompatibility typing to the outcome of transplantation of cadaveric kidneys has been controversial. Four years ago, a prospective trial began in all U.S. transplantation centers to determine whether the results of transplantation would improve with the nationwide shipment of kidneys from cadaveric donors to waiting patients undergoing dialysis when there was a match at the HLA-A, B, and DR loci. METHODS: A total of 1386 cadaveric kidneys were shipped from 108 organ centers to 198 transplantation centers and distributed among HLA-matched recipients, 1004 of whom were receiving a first transplant and 382 of whom were receiving a subsequent transplant. Graft survival in these recipients was compared with that in 22,188 recipients of first transplants and 3950 recipients of subsequent transplants whose HLA antigens differed from those of the donor. RESULTS: The rate of graft survival at one year in recipients of HLA-matched first transplants was 88 percent, as compared with 79 percent in the recipients of mismatched grafts (P less than 0.001). The estimated half-life of the kidney after the first year was 17.3 years for matched grafts, as compared with 7.8 years for mismatched grafts (P = 0.003). Among paired kidneys from 470 donors, one-year graft survival was 87 percent in the recipients of matched first grafts, as compared with 80 percent in the recipients of the contralateral kidneys, who did not have HLA matches with the donors. In donors and recipients matched for the more highly defined split Class I and Class II HLA antigens, the rate of graft survival after one year was as high as 90 percent. CONCLUSIONS: The collaborative renal-transplantation program for HLA matching of donors and recipients yielded an increased rate of one-year graft survival and an estimated half-life for matched grafts twice that for mismatched grafts. An increased role for HLA matching in kidney allocation is therefore indicated.

Adolescent↗
PubMed1992

Analyses of the UNOS Scientific Renal Transplant Registry at three years--early events affecting transplant success.

The success of cadaveric renal transplants in the first year is determined largely by events that transpire during the transplant hospitalization. This conclusion is based upon analyses of data on 19,525 cadaver donor renal transplants performed since October 1987 and reported to the UNOS Scientific Renal Transplant Registry from more than 200 centers nationwide. Graft survival rates at 1 year differed by 20-30% depending upon whether or not the transplanted kidney functioned immediately and upon whether the patient required dialysis during the first week posttransplant, experienced rejection, or was discharged with a kidney that was functioning well. Recipients whose discharge serum creatinine level was less than 2.6 mg/dl or whose graft was functioning well at the time of discharge had 88% 1-year graft survival. A multistep logistic regression analysis showed cold ischemia time, transfusions, donor age and cause of death, HLA-DR mismatches, and peak sensitization to be significant factors in the first week. Prophylactic antilymphocyte antibodies (ALG/OKT3) reduced the incidence of rejection from 30% to 20% during the transplant hospitalization, but apparently only delayed rejection. By 6 months there was only a 3% reduction with ALG and a 5% reduction with OKT3 in the incidence of reported rejection and a 2% difference in 1-year graft survival. Although graft and patient survival are important measures of transplant success, graft survival is predicted upon both early and late events. The course of the transplant during the initial hospitalization and the quality of function at discharge were the strongest determinants of 1-year graft survival.

Adolescent↗
PubMed1992

The UNOS Scientific Renal Transplant Registry.

1. One-year graft survival rates were 80%, 74%, and 66% for recipients of first (27,755), second (4,263), and multiple (914) cadaveric renal transplants, respectively. The 1-year patient survival rate was 94% for recipients of first or second grafts and 92% for multiply retransplanted patients. Half-lives projected for all cadaver transplants surviving the first year were approximately 8 years. 2. One-year graft survival rates were 95% for recipients of HLA-identical sibling-donor transplants (1,493), 91%, 90%, and 89% for recipients of 1-haplotype-matched sibling (1,787), parent (2,118), and offspring (715) donor grafts, respectively. One-year patient survival was 94% for parents receiving transplants from their children and 98% for all other recipients of kidneys from immediate family members. Projected half-lives were 26 years for HLA-identical grafts and 12-14 years for 1-haplotype-mismatched transplants from living related donors. 3. There were 181 transplants between spouses, with a 1-year graft survival rate of 92% and 99% patient survival. There were also 369 transplants from distant relatives or unrelated living donors with a 1-year graft survival rate of 86% and 95% patient survival. Projected half-lives for these transplants were 13 years. 4. Rejection episodes that occurred during the initial transplant hospitalization were reported in 24% of first and 33% of retransplanted recipients (p < 0.001). Rejection-free patients had an 85% 1-year graft survival rate compared with 67% and 58% in recipients of first or regrafts after early rejection (p < 0.001). Rejection episodes were strongly associated with histoincompatibilities. Among HLA-identical sibling transplants, 6% had early rejection compared with 12% of HLA-A,B,DR-matched cadaver transplants, 25% of parent-donor transplants and 28% of HLA-DR-mismatched cadaveric transplants. 5. The serum creatinine level (SCr) reported at the time of discharge was predictive of graft survival in both the short and long term. Recipients of first cadaver transplants discharged with SCr below 1.6 mg/dl (8,960) had a 91% 1-year graft survival rate and a projected half-life of 12 years, while those with SCr above 3.5 mg/dl had 49% 1-year graft survival and 5.3-year projected half-life (p < 0.001). Discharge SCr was significantly influenced by the recipient's weight, the donor's age, and the cold ischemia time.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Center effect in the UNOS Renal Transplant Registry.

Based upon univariate and multivariate analyses of transplant center effects: 1. Among the 115 centers selected for these analyses, there was no correlation between 6-month graft survival rates and half-lives projected for grafts surviving 6 months. 2. There was no significant center effect for living-related donor transplantations. 3. Centers that had the poorest short- and long-term survival performed more cadaveric transplants with patients in poor health at the time of transplant, more often transplanted a recipient other than the one originally identified for a particular kidney, and more often transplanted kidneys with prolonged cold ischemia, and kidneys from pediatric (age 0-11) donors, older (ages over 50) donors, Black donors, or donors who died with cerebrovascular accidents. 4. After adjusting for 17 potentially confounding variables, the difference between the best and worst center groups was the second most detrimental factor (following broad sensitization) in the first 6 months and was the factor ranked ninth in long-term survival. 5. The transplant year has emerged as a significant factor in long-term survival. This suggests that the late loss rate for transplants performed after 1988 may be diminishing. 6. The health status of the patient at the time of transplant was the dominant factor affecting long-term survival. 7. The choice of outcome variable and the selection criteria used in center classification affect the magnitude of the center effect and its relationship to other significant variables that influence graft outcome.

Adolescent↗
PubMed1992

Disease effects and associations.

1. The most common disease leading to end-stage renal disease were IDDM for Whites (36%), hypertensive NS for Blacks (26%), and CGN for Hispanics (35%) and Asians (47%). These racial differences should be taken into account in analyzing outcomes with respect to disease. 2. Differences in graft survival associated with different primary diseases were more apparent among Whites than Blacks. Race, rather than disease, was the dominant factor. 3. One-year graft survival was consistently highest for patients with IgA nephropathy (87%) and poorest for patients with SLE (78%). The difference across the spectrum of original diseases was significant (p < 0.001). 4. About 84% of White diabetics and 90% of those under age 50 had an HLA-DR3 or 4 tissue type compared with 50% of White donors (p < 0.001). The 1-year graft survival rate was 80% for DR3 or 4 IDDM patients and 74% for non-DR3/4 patients (p < 0.001). Black IDDM patients also had a significantly increased frequency of DR3 and 4 compared with Black donors (46% vs 32%, p < 0.001) and a similar trend toward higher graft survival, although the difference was not significant. 5. Of Whites transplanted with SLE, 60% had HLA-DR2 or 3 compared with 47% of donors (p < 0.001) and those with DR2 or 3 had significantly higher 1-year graft survival rates. Similar trends were noted for Blacks with SLE. 6. HLA-DR2 was present in 46 of 72 patients (64%) transplanted for Goodpasture's syndrome, compared with 28% of donors. Despite the small numbers, 1-year grafts survival was significantly better in the HLA-DR2 group (p = 0.006). 7. Significantly higher graft survival rates were observed among patients with HLA-DR1 in non-HLA-DR-associated diseases (CGN, IN, NS, or PC) but not in HLA-DR-associated diseases such as IDDM and SLE. 8. There were significant differences in recipient age and sex distributions in the major disease groups. Blacks under age 50 had significantly poorer outcomes than comparable Whites. 9. Pretransplantation health status influenced graft outcome in all disease groups. Patients with IDDM or NS were generally less healthy and correspondingly more debilitated than patients with other diseases. 10. Diabetic given a simultaneous kidney-pancreas transplant had 83% 1-year graft survival compared with 78% for those given a kidney alone (p < 0.001).

Adolescent↗
PubMed1992

Preservation.

1. There were no significant differences in 1-year graft survival rates comparing kidneys stored with 3 commonly used cold storage solutions (Collins', EuroCollins, and University of Wisconsin) over the past 12 years, even though preferences have changed sharply. 2. No significant differences in 1-year graft survival rates were noted when comparing kidneys preserved by pump perfusion and those maintained by simple cold storage. The lower incidence of delayed graft function for pump-preserved kidneys was at least partly attributable to a center effect. 3. Prolonged cold ischemia time (CIT) was associated with an increase in delayed onset of function. Of 2,718 kidneys transplanted within 24 hours, 21% did not function well within the first week. The fraction increased to 28% and 33% of kidneys transplanted between 25 and 36 hours (n = 1,858) and after 36 hours (n = 955), respectively (p < 0.01). One-year graft survival rates were 82%, 78%, and 76% for kidneys transplanted within 24 hours, between 25 and 36 hours, and after 36 hours, respectively (p < 0.01, each comparison). 4. HLA matching neutralized the impact of prolonged CIT completely. One-year graft survival was more than 86% in 715 recipients of 0 HLA-mismatched kidneys, regardless of CIT. For recipients of mismatched transplants, survival decreased by 5-6% as CIT increased from less than 24 to more than 36 hours (p < 0.01). Of the mis-matched kidneys with less than 24 hours CIT, up to 83% survived at 1 year compared with 87% of matched kidneys with more than 36 hours CIT (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Rejection episodes.

Based upon analyses of 40,671 kidney transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and August 1992: 1. Twenty-four percent of the 21,923 recipients of first cadaver grafts experienced one or more rejection episodes during their transplant hospitalization, 52% during the first 6 months. At 12 months, only 40% of patients remained rejection-free. Patients who experienced any rejection during the first 6 months had a 72% 1-year graft survival rate compared with 95% for those who remained rejection-free (p < 0.001). 2. Recipients of transplants from living donors had a significantly lower incidence of rejection episodes. There was a clear effect of histocompatibility in comparing the incidence of rejection in HLA-identical sibling transplants (8% at discharge and 32% at 1 year) with that in 1-haplotype disparate transplants (22% at discharge and 52% at 1 year, p < 0.01 at each time point). Rejections were reported for 25% of transplants from other living donors at discharge and for 56% at 1 year, similar to the figures for cadaver transplants. 3. Histocompatibility also influenced the incidence of rejection in first cadaver-donor transplants. Only 15% of recipients of 0-HLA-A,B mismatched kidneys had rejection episodes reported at discharge, compared with 26% of those who received kidneys completely mismatched for HLA-A,B antigens (p < 0.01). At 1 year, 56% of HLA-A,B matched patients remained rejection-free, whereas only 35% of those mismatched for 4 antigens had no reported rejection through the first year (p < 0.01). Considering HLA-DR antigen mismatches, 19% of the 0-antigen mismatched group had rejection episodes at discharge, versus 28% for those with 2 HLA-DR mismatches (p < 0.01), and at 1 year, the percentage who were rejection-free decreased from 48% to 40% and 34% with 0, 1, and 2 HLA-DR mismatches, respectively. 4. The incidence of rejection episodes decreased as the recipient's age increased. Patients under age 16 had the highest incidence prior to discharge (28%) and at 1 year (70%) compared with 17% and 47% at the same intervals in patients over age 60 (p < 0.01). 5. The donor's age also had a significant effect on rejection episodes. Transplants from pediatric and older donors had a higher incidence of reported rejections than those from donors aged 16-30, especially after hospital discharge.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Kidney allocation under the UNOS point system: an update.

1. The 1,480 patients awaiting cadaveric renal transplants at 14 Southern California transplant centers as of December 3, 1992, were compared with patients transplanted using a point system for one kidney and a hospital-based allocation for the second, or the current system allocating all locally procured kidneys by the point system with regard to several demographic parameters. 2. Of 1,472 waiting patients with sensitization data, 8.5% were broadly sensitized (> 80% PRA). Of the 737 kidneys allocated by the point system, 7% went to broadly sensitized patients, compared with 3% of 438 kidneys allocated by the hospitals (p < 0.001). 3. Of 1,470 waiting patients with information available, 23% were awaiting a repeat transplant. Under the point system, 18% of kidneys were used for repeat transplants compared with 9% of hospital-allocated kidneys (p < 0.001). 4. Of 1,434 waiting patients where the time waiting was available, 26% had waited 1-2 years, 12% 2-3 years, and 6% more than 3 years. Under the point system, patients waiting longer received significantly more kidneys than those recently added to the list: 35% had waited 1-2 years, 21% 2-3 years and 14% more than 3 years (p < 0.001). Kidneys allocated by the hospitals were transplanted to patients in approximately the same proportions as the waiting list: 29% to those waiting 1-2 years, 10% 2-3 years, and 3% more than 3 years. 5. Racial distribution of recipients was not significantly different under either allocation system from that of the waiting list. Whites comprised 39% of waiting patients, the same as the population of Los Angeles County.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗