Superior renal allograft survival among Asian recipients.
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Asia↗
Biomedical subjects
J M Cecka
Publications and source records attributed to J M Cecka.
The UNOS Scientific Renal Transplant Registry--1991.
Based upon data reported to the UNOS Scientific Renal Transplant Registry between October 1987 and November 1991: 1. One-year graft survival rates were 79%, 73% and 62% for recipients of first (20,864), second (3,217), and multiple (673) cadaver donor transplants, respectively. 2. One-year graft survival rates were 94%, 89%, and 90% for first transplant recipients of kidneys from HLA-identical siblings (970), parents (1,487), and 1-haplotype-mismatched siblings (1,206), respectively. 3. Half-lives calculated after the first year were 7 years for cadaver donor transplants, 11 years for parent, 12 years for 1-haplotype sibling and, 27 years for HLA-identical sibling-donor first transplants. 4. The 1-year first transplant survival rate has improved from 78% in 1987-88 to 80% in 1990-91 transplants (p = 0.001). There has been an attendant decline in the percentage of broadly sensitized patients transplanted from 15% in 1987 to 8% in 1990 (p less than 0.01), which may have contributed to rising survival rates. 5. There has been a remarkable improvement in the 1-year graft survival of retransplanted patients from less than 70% in 1987-88 to 78% in 1990 (p less than 0.001). This improvement has been most notable in broadly sensitized patients and those with delayed graft function. 6. Diabetics who received a pancreas and kidney transplant (995) had 81% 1-year graft survival compared to 77% for those who received a kidney transplant only (p less than 0.002). 7. One-year graft survival rates decreased significantly in recipients of kidneys from donors aged under 16 or over 45. Survival was less than 70% when the donor was under 5 or over 60 compared to 81% when the donor was aged 16-45 (p less than 0.001) for recipients of first cadaver transplants. Delayed graft function occurred in 40% of cases when the donor was over 60 and 28% of cases when the donor was under 5. When function was delayed, survival was 50% for these marginal kidneys compared to 68% for younger adult kidneys with delayed function (p less than 0.001). Rejection also had a greater impact on survival of kidneys from donors under 5 or over 60. 8. The 1-year graft survival rate for 2,504 first transplant recipients of cadaver kidneys from young male victims of traffic accidents was 85%. The 1-year graft survival of 2,670 patients given kidneys from older female donors who died of cerebrovascular accidents was 73% (p less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Center effects in renal transplantation.
1. One-year graft survival rates for first cadaver transplants to adult recipients ranged from 60-93% at transplant centers reporting more than 50 transplants to the UNOS Renal Transplant Registry between October 1987 and December 1991. 2. There was no apparent correlation between center size and success rates for primary or repeat cadaveric transplants when centers were grouped according to high, average, and low 1-year graft survival rates. 3. Fifteen "high" centers had 88%, 15 "average" centers had 80%, and 15 "low" centers had 69% 1-year graft survival rates, respectively. 4. Projected half-lives for transplants surviving the first year were not significantly different among the 3 center groups, suggesting that long-term survival did not correlate strictly with 1-year survival. 5. The 20% difference in 1-year graft survival rates between the high and low center groups was reduced to 10% and to 5% when transplants functioning at discharge or at 6 months, respectively, were considered. Thus, approximately half of the center effect was associated with events that occurred during the transplant hospitalization. 6. At high and average centers, less than 10% of kidneys did not function on the first day compared with 17% at low centers (p less than 0.01). Twenty percent of patients at high and average centers required dialysis during the first week compared with 37% at low centers (p less than 0.01). Less than 5% of kidneys never functioned during the transplant hospitalization at high and average centers compared with 10% at low centers (p less than 0.01). 7. Graft survival rates for patients with early graft dysfunction were significantly higher at high centers than at average or low centers, suggesting that successful management of patients with poor early function differed among the center groups. 8. Low centers transplanted more Blacks and fewer healthy patients than high centers, but when stratified for these variables, the center differences in graft outcome were undiminished. 9. Other patient mix variables, including age, sensitization, and original disease, did not account for variation in survival rates for the center groups. High centers transplanted more diabetics (33%) than average (25%) or low (18%) centers. 10. There were no significant differences among the center groups in the incidence of early rejection episodes. However, graft survival following rejection was 10-30% lower at average and low centers than at high centers.(ABSTRACT TRUNCATED AT 400 WORDS)
Cadaver↗
Sex and age effects in renal transplantation.
1. Since 1985, 1-year graft survival in first cadaver transplants has remained constant at 78-80%. One-year graft survival rates for recipients over age 50 improved with CsA from 58% in 1981-82 to 78% in 1985-86. Survival in recipients under age 10 was 70% from 1985 to 1988, but improved to 75% in transplants performed in 1989-90. 2. The percentage of immunologic failures decreased from 75% in recipients aged 1-10 to 54% in recipients aged over 50. Thirty percent of males aged 1-10 had rejection episodes during the transplant hospitalization compared with 15% of males over age 50. These findings support earlier studies suggesting young recipients have a stronger immune response. 3. The incidence of nonimmunological failures increased from 10% in recipients under age 30 to more than 30% in patients over age 50. 4. There were no significant differences in graft outcome associated with the recipient's sex. 5. Kidneys from donors aged 1-10 or over 50 yielded poorer results than those from adult donors aged 11-50. This donor age effect was most notable in broadly sensitized, retransplanted, or HLA-B,DR-mismatched recipients. 6. Discharge serum creatinine (SCr) levels over 2.5 mg/dl were reported for more than 40% of recipients given kidneys from donors under age 5 or over age 50. When the discharge SCr was less than 2.5 mg/dl, 1-year survival was 90%, regardless of the donor age. 7. Trauma deaths accounted for 90% of kidneys from male donors aged 15-30 and 70% of comparable aged female donors. Cerebrovascular accidents were the cause of donor death for 43% and 68% of kidneys from male and female donors over 30, respectively.
Adolescent↗
Race effects.
1. One-year graft survival rates for cyclosporine-treated first cadaver donor transplants were 80% for 14,911 White recipients, 74% for 3,845 Blacks, 84% for 951 Asians, and 81% for 1,319 Hispanics reported to the UCLA Renal Transplant Registry between January 1984 and December 1991. 2. One-year graft survival rates for similar transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and December 1991 were 83% for 10,518 Whites, 79% for 3,655 Blacks, 82% for 429 Asians, and 84% for 1,277 Hispanic recipients. 3. Transplant half-lives calculated after 6 months were 10 years for Asian recipients, 9 years for Whites, 6 years for Hispanics, and 4 years for Black recipients (UCLA Registry). 4. Patient survival was 93% and 85% at 1 and 3 years, respectively, for both Black and White recipients of first cadaver transplants. Patient survival was 94% and 89% at 1 and 3 years, respectively, for Asian and Hispanic recipients (UCLA Registry). 5. Asian recipients had significantly better graft survival than Whites (4% through 3 years, p less than 0.05). This high survival was not affected by donor race, although HLA-matching was remarkably better in Asian-to-Asian combinations than White-to-Asian, nor by whether the transplant was performed in the United States or Canada, or at other international centers (UCLA Registry). 6. The poor graft survival of Black recipients at 1 and 3 years was strongly influenced by age-dependent factors. Black recipients of either sex aged 16-30 had the poorest graft survival rates (UCLA Registry). 7. Blacks were sensitized more often than Whites (17 vs 15%, p less than 0.01). Even moderate sensitization reduced 1-year graft survival from 76% to 71% (p less than 0.05) in Blacks whereas there was no effect in recipients of other races. By contrast, broad sensitization did not affect 1-year graft survival in Hispanic recipients (UCLA Registry). 8. Blacks received more poorly HLA-matched transplants than recipients of other races. Only 2% received HLA-A,B-matched kidneys and 29% received completely HLA-A,B-mismatched transplants (p less than 0.01). More than 30% received transplants mismatched at 2 HLA-DR antigens (p less than 0.01) (UCLA Registry). 9. Although there were clear racial differences in the original diseases leading to end-stage renal disease, the recipient's race was a stronger predictor of graft outcome than disease (UCLA Registry).(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Recent improvements in cadaver-donor kidney retransplantation.
1. Since 1988, 1-year graft survival rates of first cadaver transplants have improved from 78 to 80% (p less than 0.01) in both the UCLA and UNOS Renal Transplant Registries. During the same period, regraft survival has improved from 66 to 75% (p less than 0.0001) in the UNOS data and from 67 to 70% in the UCLA Registry. 2. The UCLA Registry data show a decrease in the proportion of high-risk patients [based upon previous graft survival time (PGST) less than 6 months] retransplanted each year from nearly 50% in 1986 to 35% in 1990. This decrease in a dominant risk population may contribute to rapidly improving retransplant survival. 3. Retransplanted patients with a PGST less than 6 months had a 1-year regraft survival rate of 62% versus 74% for those with a PGST longer than 6 months. 4. Sensitization, a positive crossmatch by flow cytometry, HLA-DR mismatches, and Black race were significant high-risk factors in retransplant recipients with a short PGST. For long PGST patients who rejected their previous graft more than 6 months postoperatively, these factors were far less detrimental or had no influence on the outcome. 5. The flow cytometry crossmatch improved 1-year regraft survival from 34% in 30 positive cases to 65% in 28 negative cases for the short PGST patients. More sensitive crossmatch methods may also have contributed to improving regraft survival rates. 6. The 1-year regraft survival in HLA-DR matched short PGST patients was 64% versus 52% with 2 antigens mismatched (p less than 0.01). A yearly analysis of HLA-DR mismatching showed that the number of patients with 2-DR mismatches increased whereas those with no mismatches decreased. The importance of HLA-DR mismatches should be underscored for short PGST patients. 7. Blacks with a long PGST had the same high regraft survival as Whites through the first 3 years. Blacks with a short PGST had an 8% lower 1-year regraft survival rate than Whites (p less than 0.0001). 8. Although patient selection and screening tests for preformed antibody may have contributed to rising regraft survival, the concomitant rise in first transplant survival suggests that improvements in immunosuppression strategies and patient management are also beginning to affect outcomes in the multicenter data.
Adolescent↗
Sensitization in renal transplantation.
1. The 1-year graft survival rate for 2,615 broadly sensitized patients of first cadaver-donor transplants between 1985 and 1990 was 72%, 7% lower than 15,615 nonsensitized patients and 6% lower than 4,824 moderately sensitized patients. For retransplants, 1,752 broadly sensitized patients had 61% 1-year graft survival rates, 12% lower than 1,299 nonsensitized patients and 8% lower than 1,104 moderately sensitized patients. 2. Rejection of a previous transplant, pretransplant blood transfusions, sex, and a history of pregnancies were the dominant causes of sensitization. 3. The percentage of nontransfused recipients of first cadaver transplants has increased yearly from 10% in 1985 to more than 40% in 1990 in both the UCLA and UNOS Registries. Over the same period, the percentage of broadly sensitized recipients has declined from 15% to 8%. 4. The beneficial effect of pretransplant transfusions (a 4% improvement at 1 year) was limited in first transplants to males and nonsensitized females. No difference in survival rates of sensitized patients comparing transfused and nontransfused was observed. Patients retransplanted without ever being transfused had very poor outcomes. 5. Delayed graft function (DGF) occurred in approximately 20% of nonsensitized, 28% of moderately (1-50% peak PRA), and 37% of broadly sensitized first transplant recipients. Among retransplanted patients, 28% of nonsensitized, 37% of moderately, and 48% of broadly sensitized patients had DGF. 6. HLA-A,B, and DR matching overcame the deleterious effect of sensitization on graft survival. Sensitization had no effect on the outcome of transplants from HLA-identical siblings, but survival decreased by 7-10% in sensitized recipients of mismatched transplants from relatives. Sensitized first cadaver transplant recipients matched for HLA-A,B, or HLA-DR antigens had 1-year survival rates comparable to those of mismatched nonsensitized recipients. 7. First transplant recipients who were nonsensitized using their current serum but had been broadly sensitized in an historical sample had 73% 1-year graft survival, the same as that of patients who were broadly sensitized in their current serum and 6% less than patients who were never sensitized (p less than 0.001). 8. Assuming a random distribution of sensitized patients at UNOS transplant centers using different methods to measure preformed antibody, the antihuman globulin (AHG) method was more sensitive than the NIH or 1-Wash tests. With AHG, 31% of first and 58% of retransplanted patients were broadly sensitized, whereas with the NIH and 1-Wash methods, the corresponding figures were 18-21% and 41-44%.(ABSTRACT TRUNCATED AT 400 WORDS)
Blood Transfusion↗
UCLA and UNOS Registries. Overview.
The subjects of this study were transplant recipients entered in the UCLA Registry file since 1984 and in the UNOS Registry since 1987. [table: see text] 5. Based on the data above, we conclude that the near 20% loss rate in the first year can be roughly allocated as follows: death 3%, technical 3%, agonal kidney damage 6%, and histocompatibility differences 7%. 6. The quality of HLA typing was assessed by examining the frequencies of the various specificities reported for cadaver donors in 8 yearly periods from 1984 to 1991. The A and B loci specificities were remarkably constant. The DR specificities were still undergoing stabilization. 7. No urine output on the first day, which occurred in approximately 10% of the first cadaver-donor transplants, resulted in about a 20 percentage point lower graft survival rate at 1 year. 8. Anuria on the first day increased with cold ischemia time, donor age, cerebral vascular accident donors, and retransplant recipients. 9. Graft survival with anuria on the first day and: [table: see text] 10. When dialysis was required during the first week, there was an approximate 15 percentage point decrease in 1-year graft survival in 25% of the patients. 11. One rejection in the first hospitalization period resulted in 67% 1-year graft survival. More than 1 rejection led to 57% 1-year graft survival. 12. Serum creatinine at discharge was an accurate indicator of subsequent graft survival. Approximately a 7 percentage point drop in 1-year graft survival was noted with each unit of serum creatinine above 2.0 mg/dl.
Adolescent↗
Early rejection: determining the fate of renal transplants.
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Blood Transfusion↗
Molecular HLA matching.
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Graft Survival↗
A report from the UNOS Scientific Renal Transplant Registry.
The UNOS Kidney Transplant Registry is now fully operational. Aside from scientific reports from UCLA, analysis of the same data base from investigators who initiate projects through UNOS central in Richmond, as well as from HICFA and USRDS, can be anticipated. Plans are underway to simplify the reporting process. With the large number of accumulated cases, it should be possible to analyze many factors in the future. Presently, histocompatibility differences in living related vs cadaver donors and degrees of HLA mismatching among recipients of cadaveric kidneys are major factors. Immunization by transplant rejection is the second most important factor.
Graft Survival↗
The transfusion effect in cadaver kidney transplants--yes or no.
The transfusion effect in first cadaver kidney transplants was re-examined at the UCLA Transplant Registry. One-year graft survival rates were 71% for non-transfused patients, which improved to 75% (P less than 0.05) with a single transfusion, 77% (P less than 0.01) with 2, and 78% (P less than 0.01) with 3 and 4 transfusions. One-year graft survival rates did not improve further with additional transfusions but remained at the same level. Thus, the transfusion effect clearly does exist, and 2 to 4 transfusions are sufficient to obtain the maximum beneficial transfusion effect. Patients with zero HLA-DR mismatched transplants had no blood transfusion effect. Transfusions improved the 1-year graft survival rate by 8% for transplant recipients with 1 DR-mismatched grafts (P less than 0.01) and by 10% with 2 DR-mismatched grafts (P less than 0.01). The transfusion effect was greater in Black than White recipients; however, the 77% 1-year graft survival rate for transfused Black recipients of zero DR-mismatched kidneys did not differ from that of transfused comparably matched Whites. We conclude that transfusion protocols should not be abandoned unless patients receive zero DR-mismatched kidneys.
Black People↗
The UNOS Scientific Renal Transplant Registry--1990.
Based upon data reported to the UNOS Scientific Renal Transplant Registry between October 1987 and October 1990: 1. One-year graft survival rates were 78% for 14,203 recipients of first cadaver donor transplants, 70% for 2180 recipients of second cadaver transplants, and 59% for 487 recipients of third or fourth transplants. First transplants from living donors had 90% 1-year graft survival. 2. One-year graft survival was 75% for 2,273 Black recipients of first cadaver transplants and ranged between 79-80% for recipients of other races (p less than 0.001). 3. Broadly sensitized (50% peak PRA) first cadaver transplant recipients had 77% 1-year graft survival versus 79% for nonsensitized or narrowly sensitized recipients. Cadaver retransplant recipients with greater than 10% peak PRA had 65% 1-year graft survival while those transplanted with no antibody had 78% (p less than 0.001). Survival of nonsensitized retransplanted patients was not significantly less than first transplant recipients. 4. Graft survival was 78% at 1 year for both male and female recipients of first cadaver donor transplants. Retransplanted females had significantly higher 1-year graft survival at 70% than males at 67% (p less than 0.01). Male donor kidneys had significantly higher survival rates than female donor kidneys in both first and retransplanted patients. One-year graft survival was 79% and 70% with male donors and 75% and 65% with female donors in first and retransplants, respectively (p less than 0.01). 5. Pediatric recipients (under 16) and older recipients (over 60) of first cadaver transplants had 73% 1-year graft survival compared to 78-79% for those aged 16-60. 6. Among recipients of first cadaver transplants, 1-year graft survival rates varied over a 20% range with the age of the donor. Excluding pediatric and older patients, the best survival rates (81%) were obtained with kidneys from donors aged 16-45. Kidneys from younger and older donors yielded progressively poorer results. The lowest survival was with 181 donors aged 1-5 (60%) and 145 donors over 60 (69%). 7. One-year graft survival was 85% for 274 recipients of 0 HLA-A,B,DR-mismatched first cadaver transplants and 74% for 717 recipients of transplants mismatched for 6 HLA-A,B,DR antigens. Graft survival progressively declined with increasing histoincompatibility. 8. One-year graft survival decreased by 20% if the kidney failed to produce urine in the first hour, from 80-60% in first transplant recipients and from 72-50% in retransplanted patients.(ABSTRACT TRUNCATED AT 400 WORDS)
Cadaver↗
The UNOS Scientific Renal Transplant Registry: multistep regression models on kidney graft survival.
1. Two-step Cox regression analyses showed that, for White recipients of first cadaver transplants, pretransplant transfusions, HLA-DR mismatch, donor race, CIT, size mismatch, PRA, old donor, and recipient age were significant prognostic factors during the first 6 months posttransplant, and after that, older donor, CIT, and size mismatch continued to have effects on graft survival in the longer term. 2. For African-American recipients of first cadaver transplants, pediatric donor, cause of donor death, and increasing second warm ischemia time were major risk factors in the early period, but in the late period, the effect of donor age dominated other factors. 3. Multistep linear logistic regression and two-step Cox regression analyses yielded similar results, with donor-related and histocompatibility factors dominating survival outcome in both the short and long terms.
Adult↗
Pediatric recipients and donors.
1. Pediatric recipients comprised 6% of first cadaver transplants, 9% of cadaver retransplants, and 4% of parent donor transplants reported to the UCLA Transplant Registry between January 1984 and December 1989. 2. Very young pediatric patients (aged 1-5) had consistently poorer 1-year graft survival than older pediatric or adult recipients. Graft survival was 65%, 46%, and 86% at 1 year for first cadaver, cadaver regrafts, and first parent donor transplants, respectively. The comparable ranges for recipients over 5 years old were 73-77%, 65%, and 88%. 3. The poor outcomes for very young pediatric recipients of first cadaver transplants were mitigated by using adult male donor kidneys (75% 1-year survival) and HLA-B,DR matching (75% 1-year graft survival with 0-1 B,DR mismatch). 4. One-year graft survival improved from 66-78% with pretransplant transfusions in 11 to 18-year-old first cadaver transplant recipients (p less than 0.05), whereas transfusions improved 1-year graft survival in adult recipients by only 3%. 5. Cadaver kidneys from donors aged 1-5 yielded the lowest 1-year graft survival rate in first transplants (68%) and in regrafts (46%), whereas those from donors aged 16-18 yielded the best results (81% in first transplants and 66% in regrafts). 6. The poorest graft survival rates for each recipient age group resulted with kidneys from very young donors (aged 1-5). The lowest survival rate (51%) resulted when kidneys from donors aged 1-5 were used for recipients aged 1-5. 7. Prolonged CITs in excess of 30 hours had an extremely adverse effect on kidneys from donors aged 1-5. Kidneys from donors aged 1-5 with less than 18 hours CIT yielded 75% 1-year first transplant survival, whereas only 57% of those with more than 30 hours CIT survived. 8. The overall poorer outcome for very young pediatric recipients was apparently due to the use of age-matched donors for this group. Over 40% of first transplant recipients aged 1-5 received cadaver kidneys from donors aged 1-5.
Adult↗
Sex and age effects in renal transplantation.
1. The age and sex of the recipient were not significant factors in transplant outcome. The age and sex effects observed were all associated with the kidney donor. 2. The 1-year graft survival rates for male and female donor kidneys were 78% and 76%, respectively in first cadaver transplants and 91% and 88%, respectively, in parent donor first transplants. The donor sex had no significant effect on survival of transplants from sibling donors, irrespective of HLA match. 3. Long-term survival rates, reflected in transplant half-lives, were also significantly better in recipients of male cadaver (8 years) or paternal donor (13 years) first transplants than in recipients of female cadaver (6 years) or maternal donor (9 years) kidneys. 4. A higher percentage of HLA-A,B matched cadaver kidneys than mismatched organs were transplanted to sensitized recipients. Despite a higher percentage of sensitized female recipients, there was no difference in first cadaver transplant survival comparing males and females. 5. A positive flow cytometry crossmatch (FCXM) was associated with poor 3-month cadaver retransplant survival in both males (54%) and females (56%) compared with 83% and 76%, respectively, for FCXM-negative males and females. 6. The impact of preformed antibodies on first cadaver transplant outcome differed between males and females. Among sensitized recipients, females had 83% and 81% 3-month graft survival with a positive and negative FCXM, respectively, whereas positive FCXM male patients had 71% vs 86% for FCXM-negative males. 7. Graft survival ranged from 76%-79% in first transplant recipients aged 1-5, 6-14, 15-55, and over 55 when the cadaver donor age was 15-55. Poorer survival rates in pediatric and older recipients were associated with "age-matching" the donor kidney. Nearly 40% of pediatric patients received kidneys from pediatric donors that did poorly in all recipient age groups. More than 20% of kidneys from donors over 55 were transplanted to older recipients. These older donor kidneys also had uniformly poor survival in all recipient age groups. 8. When death was excluded as a cause of graft loss in first cadaver transplants, patients over 55 had an 80% 1-year graft survival rate. Although death was clearly a factor for older patients, it was interesting that survival including death was 76% when the donor age was 15-55 and 63% when the donor was over 55.
Age Factors↗
Effect of race on kidney transplants.
1. The 1-year graft survival rate for 3,525 Black recipients of first cadaver-donor transplants between 1985 and 1989 was 71%. For 13,866 Whites it was significantly higher at 78%, and 796 Asians had the highest 1-year graft survival rate at 83%. 2. When transplant centers were grouped according to the number of Black patients transplanted between 1985 and 1989, 1-year graft survival rates for Blacks ranged from 67% at centers that transplanted more than 100 Blacks to 74% at centers with 50-100 Blacks to 69% at centers with 1-50 Black transplants. The corresponding survival rates for Whites were 74%, 78%, and 78%, respectively (p less than 0.01 at each center group). 3. When the results were further stratified according to donor race and age, HLA-DR mismatches, and transfusions, a significant 6% difference remained between graft survival rates of Black and White recipients (p less than 0.01). 4. Similar stratified analyses for donor race yielded a significant 8% lower survival rate for Black donor kidneys compared to White donor kidneys (p less than 0.01). 5. More than 25% of Black recipients and donor kidneys were transplanted at 6 of the 204 centers reporting to the UCLA Transplant Registry, whereas 92 centers had transplanted no Black patients. 6. The main difference in survival between Whites and Blacks was among younger patients. There was a 13% difference for those younger than 30 (p less than 0.01), and only a 4% difference among patients older than 45 (p less than 0.05). 7. When HLA-DR antigens were matched, there was no difference in the survival rate between White and Black patients. This result was unaffected by the race of the donor, implying that racial HLA-DR variants may not be a major consideration in matching. 8. Black patients had poor long-term graft survival. The kidney half-life calculated after the first year for Black recipients was 3.7 years, and was 8.7 years for Whites (p less than 0.01). 9. There was a clear "center effect" component to racial differences in first cadaver kidney transplant outcomes related to the size of the Black recipient population. These center effects did not account for the overall difference between Black and White survival rates.
Age Factors↗
Cadaver retransplants.
1. Second-graft survival rates were 67% at 1 year and declined to 40% at 5 years, consistently 10% lower than those of first grafts. First- and third-graft survival rates were 77% and 58% at 1 year, respectively. The difference was apparent at 3 months. 2. Second transplants with good 1-month function had an 82% 1-year graft survival rate compared to 86% for first transplants. With good 3-month function, they had 89% 1-year survival, comparable to 91% for first transplants. 3. First-graft duration had a high prognostic value for second-graft survival. Second transplants with first-graft duration less than 3 months had 57% 1-year graft survival whereas those with more than 12 months had 75% 1-year survival. The difference was significant up to 5 years. Half-life after 1 year was 5.9 for acute responders and 5.3 for chronic responders. 4. The FCXM was a useful screening tool for second transplants. Second transplants with positive FCXM had 61% 3-month survival and those with a negative crossmatch had 82%. A positive FCXM with short first-graft duration had 48% 3-month survival and should be a contraindication for retransplantation. 5. Responder status was associated with HLA-mismatches in the first transplants. The 0-HLA-mismatched first grafts resulted in acute responders for 45-58%, which was significantly lower than 62-69% of totally HLA-mismatched first grafts. Totally HLA-mismatched first grafts were related to 3-18% lower survival for acute responders. 6. Acute responders benefited more from HLA matching than chronic responders. In acute responders, 0-HLA-A,B-mismatched grafts had a 72% 1-year graft survival rate, and 4 mis-matched had 58%. At 3 years, they had 59% and 42%, respectively. 7. HLA-DR1 recipient phenotype was associated with a 10-15% increased survival rate. DR1-positive recipients had 73% 1-year survival compared to 63% of DR1-negative recipients. 8. Never-transfused second-transplant recipients had a 59% 1-year survival rate compared to 69% for transfused. Transfusions of 1-4 units were sufficient to obtain a transfusion effect. 9. The antihuman immunoglobulin crossmatch test was associated with a 3-8% better 2-year graft survival in first and second transplants. There was no short-term beneficial effect. This assay might have detected false-negative crossmatch cases not seen by NIH or one-wash.
Antibody-Dependent Cell Cytotoxicity↗