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J M Cecka

Publications and source records attributed to J M Cecka.

At least 127 records · Page 7Linked to original sources
PubMed1990

Early rejection: analyses of the UNOS Scientific Renal Transplant Registry.

1. Rejection was the major cause of first cadaver transplant failure, accounting for 62% of failures in the first 3 years of data in the UNOS Scientific Renal Transplant Registry. 2. During the transplant hospitalization, 27% of recipients experienced 1 or more rejection episodes. The 1-year graft survival rate for patients with rejection was 65%, whereas for those who were rejection free at discharge, survival was 85%. Patients who remained rejection free through the first 6 months had a 1-year graft survival rate of 95%. 3. The incidence of early rejection decreased as the recipient's age increased. Only 18% of patients over 60 had rejection prior to their hospital discharge, and 33% of patients under 15 had early rejections. 4. The incidence of rejection was 20% for Hispanics, 27% for Whites, and 30% for Blacks. Despite the significant difference in early rejection between White and Hispanic recipients, there was no difference in the 1-year graft survival rate comparing these racial groups. Blacks had significantly poorer survival whether or not rejection occurred early than White or Hispanic recipients. 5. Sensitization had no apparent effect on the likelihood of early rejections for first transplant recipients, but graft survival was 54% for sensitized patients with rejection and 64% for nonsensitized rejection patients. 6. Prophylactic antilymphocyte antibody (ALG or OKT3) reduced rejections during the transplant hospitalization from 30% to 20%. Patients given ALG or OKT3 prophylaxis had a significantly higher incidence of rejection between discharge and 6 months than those who did not receive either treatment. There was no significant improvement in 1-year graft survival for patients treated with antibody.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed1989

Overview and epitope matching.

1. Kidney graft survival rates have stabilized over the past 4 years, suggesting that gains achieved with CsA have plateaued. The overall 1-year graft survival is 77% for first cadaver donor transplants, 90% for parental donors, and 93% for HLA-identical sibling donors. Patient survival for all categories is now over 95%. 2. The UNOS 6-antigen match program has resulted in outstanding graft survivals. Of 88 kidneys which were transplanted into first graft recipients, the 6-antigen match kidney had a 1-year graft survival of 91% compared to 74% for the contralateral kidney transplanted locally (p less than 0.008). 3. In highly sensitized patients with more than 80% PRA the shipped 6-antigen matched kidney had a 91% 1-year graft survival rate compared to 72% survival in comparable control patients from the registry (p less than 0.005). In patients with less than 80% PRA, 6-antigen matched kidneys had 90% 1-year graft survival compared to 80% in controls (p less than 0.00001). 4. The spread of 1-year graft survival rates at 68 centers that performed more than 100 transplants was 63-94%. The cumulative graft survival of 6-antigen matches performed at 129 different centers was 90%. Thus, the strong center effect was neutralized by the use of matched transplants. 5. In contrast to the 1% of patients who would receive O-B,DR mismatched transplants on a random basis, if kidneys were shared in the national pool, 74% could receive such a transplant. We therefore propose that a keep one-share one policy be adopted for all kidneys harvested in the United States. If no 0-B,DR mismatched patient is available, both kidneys will be kept by the harvesting center. Since 63% of kidneys are currently being shared with other centers for various reasons, the 75% sharing suggested by the new system should not impose a hardship on transplant centers. The UNOS payback agreement will be replaced by this agreement by which shipping will be done only to achieve excellent matches. 6. In order to achieve a better method of excluding the worst mismatches, an attempt was made to develop a new method of mismatching using amino acid sequences of the HLA specificities. Donor and recipient types can be converted to amino acid sequences and the mismatching done on the basis of amino acids of mismatch at each residue or position. For each residue, specific combinations of amino acid substitutions were examined individually to determine their effect on graft survival. From these studies, a list of "immunogenic" amino acids was prepared, and graft survival was then computed for increasing numbers of amino acids of mismatch.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

The UNOS Scientific Renal Transplant Registry.

1. After 2 years of data collection and compiling, the UNOS Scientific Renal Transplant Registry was analyzed for the first time. One-year graft survival rates were 89% for first parent donor transplants (257), 76% for first cadaver (7,049), 65% for second cadaver (1,072), and 57% for multiple retransplant recipients (221). 2. The side-by-side comparison of the UNOS and UCLA registries revealed a remarkable similarity between results from the 2 databases. The concordance between the registries makes us confident in the validity of the UNOS data and also suggests that centers submitting data to the voluntary UCLA Registry are representative of the national experience. 3. Eighty-nine recipients of 6-antigen matched first cadaver transplants were identified in the UNOS Registry with 88% graft survival at 1 year. This result is comparable to that obtained from surveys that identified 224 recipients with 90% graft survival at 1 year. These results underscore the importance of sharing cadaver kidneys to achieve perfectly matched transplants. 4. Blood transfusions improved graft survival by 5% at 1 year. More than one-quarter of the first cadaver transplant recipients were nontransfused. 5. The first follow-up report after discharge of the transplant recipient was requested at 6 months by UNOS. This delay in reporting transplant outcome resulted in a serious lag between the time a transplant was performed and its availability for analysis. The UCLA Registry collects a report at 3 months and had more recent transplants available for analysis.

Databases, Bibliographic↗
PubMed1989

Effect of sex on kidney transplants.

1. Recipient sex had no effect on first cadaver kidney transplant survival. In cadaver regrafts performed prior to 1984, male recipients consistently had lower 1-year graft survival than female recipients. Since 1984 there has been no difference associated with recipient sex. 2. Female donor kidneys had poorer graft survival rates than male donor kidneys. This difference became significant in first cadaver transplants since 1983 and was more evident in retransplants. The difference in regraft survival rates associated with the donor's sex has been dramatically reduced in more recent transplants if the projected results from 1989 transplants are correct. 3. Use of cyclosporine (CsA), pretransplant transfusions, and HLA-A,B mismatches independently contributed to the poorer survival rates of female donor kidneys. A large component of the donor sex effect may have been related to CsA toxicity. 4. Broadly sensitized (greater than 50% PRA) recipients of first transplants had 8% lower 1-year graft survival rates when they received a female donor kidney. 5. Female donors between the ages of 36 and 45 years yielded significantly lower 1-year graft survival rates in recipients of both first transplants and regrafts. This may represent a special donor risk group.

Adolescent↗
PubMed1989

Effect of age on kidney transplants.

1. Graft survival rates ranged from 72-78% at 1 year for recipients over the age of 6 years. Only the very young pediatric recipients had a low 64% 1-year graft survival rate. 2. Older recipients (over 55 years) had a significantly lower 1-year patient survival rate. When we considered death with a functioning graft as a transplant success, older patients actually had the highest graft survival rate. 3. Donor age had an overriding effect on graft survival. The 1-year graft survival rates were 78% for recipients of kidneys from adult donors, 59% from younger pediatric donors, and 67% from older donors. 4. One-year graft survival rates were uniformly over 80% in transplants with no HLA-B,DR antigens mismatched, regardless of recipient or donor age (except when the donor was over 55). The 1-year survival rate for younger pediatric donor kidneys was 62% or less when there were HLA-B,DR mismatches. 5. Pretransplant transfusions improved graft survival by 2-4% in recipients of adult donor kidneys. In recipients of younger pediatric kidneys, graft survival improved by 20% at 1 year with 1-2 transfusions. The enhancing effect of transfusions and matching in recipients of smaller pediatric kidneys is consistent with the idea that these kidneys are more vulnerable to rejection than those from adult donors. 6. Pediatric donors (younger than 15 years of age) accounted for approximately 15% of all donors, whereas pediatric recipients only constituted 2.8% of all recipients in the period of 1984 to 1988. Most kidneys derived from pediatric donors have to be given to adult or older recipients.

Adolescent↗
PubMed1989

Sensitization and crossmatching in renal transplantation.

1. Presensitization in first cadaver kidney recipients can lead to increased risk of graft failure by hyperacute rejection, or delayed function up to 1 month. Fifty percent of the hyperacute rejections occurred in nonsensitized recipients. The number of "classical" hyperacute rejections was small, but they have been occurring at a rate of about 10 per year. 2. One-year graft survival of nonsensitized recipients of first and second cadaver transplants was about the same. One-year graft survival of broadly sensitized recipients of first and second cadaver transplants was 8% lower than those who were moderately sensitized. One-year graft survival of second cadaver transplants in all sensitized recipients was significantly lower (9-13%) than in first cadaver transplants. 3. The proportion of transfused recipients was 89% in parous females, 84% in nulliparous females, and 80% in males. Pretransplant transfusions also increased sensitization of males and females awaiting their first kidney transplant. Females were significantly more sensitized than males, whether they were transfused or not. 4. One-year graft survival rates of transfused recipients were 5-9% higher than nontransfused recipients. Highly sensitized patients who were transfused had the same 1-year graft survival as nontransfused, nonsensitized recipients. 5. Patients in Southern California waiting for a second transplant were more broadly sensitized than those waiting for a first kidney. A higher proportion of sensitized patients were waiting more than 3 years for a second transplant than for a first. 6. Patients waiting for a first transplant were more sensitized than those transplanted for the first time. The highest number of waiting or transplanted patients was blood group O. 7. A significantly greater proportion of sensitized patients with blood groups A and B was waiting than those with blood type O. The type O patients were transplanted at the same rate as they entered the waiting list. It is possible that sensitized type O patients were being discouraged from entering the waiting list. 8. A significantly smaller proportion of broadly sensitized SLE patients was waiting for a first transplant since 1988, although SLE patients were more broadly sensitized compared to those with other diseases and waiting since 1981 to 1987. This further confirms that many SLE patients are transplanted, as their sensitization is more often associated with autoantibody. 9. The highest proportion of currently sensitized recipients occurred in the transplants with 0 mismatches for the HLA-A,B specificities of the donor kidney.(ABSTRACT TRUNCATED AT 400 WORDS)

ABO Blood-Group System↗
PubMed1989

Second transplants.

1. One-year graft survival for recipients of second cadaver renal allografts was 66%, 10% below that of first transplant recipients. The poor second graft survival rates have not improved since the introduction of cyclosporine A in 1984. 2. The major difference between first and second transplants was a higher rate of immunological failures in the first 3 months. Whether or not the second transplant functioned on the first day was a good indication of the outcome. 3. The degree of HLA mismatching in the first transplant affected second graft survival. When there were no HLA-B,DR mismatches in the first transplant, 1-year second graft survival was 72% compared to 66% when there were mismatches. 4. HLA-A,B,DR matching in the second transplant also improved second graft survival from 65% for completely mismatched grafts to 78% when there were no antigens mismatched. 5. The duration of the first transplant was an important consideration in second graft survival. When the first transplant had functioned for more than 1 year, second graft survival was 74%. When the first graft had been lost within 3 months, second graft survival was less than 60%. 6. Early second graft function in patients whose first transplant had functioned more than 6 months paralleled that of first transplant recipients. When the first transplant was lost within 6 months, 30% of second transplants never functioned or were lost in the first month. With a longer duration first graft, only 10% were lost in the first month. 7. Sensitization, though a predictive factor of second graft survival, was less informative than the first transplant duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗
PubMed1989

The race effect.

1. One-year graft survival rates were 93% for recipients of HLA-identical sibling transplants in Blacks and Caucasians. One-year graft survival rates were lower in Blacks than Caucasians by 6% for parent donor, 8% for first cadaver, and 4% for cadaver donor retransplants between 1984 and 1989. 2. Although 1-year graft survival was consistently lower in Black recipients, there was no significant race difference when the recipient was over age 45 years. In transplants performed after 1986, there was no significant race difference when the recipient was over age 30 years. 3. Black recipients aged 15-30 years had the poorest 1-year graft survival at 64% each year between 1984 and 1988. One-year graft survival in comparable Caucasian recipients improved from 73-82% during this interval. The difference was greatest (18%) when comparing young Black and Caucasian males. 4. Caucasians had better early function than Blacks as judged from serum creatinine levels in the first 60 days. Fifty-two percent of Caucasians had excellent function (SCr less than 1.5 mg/dl) vs 37% of Blacks. Conversely, 22% of Blacks had SCr levels that never fell below 2.5 mg/dl vs 16% of Caucasians. There was no racial difference in early graft survival when transplants were stratified by function. The race effect became apparent after 6-12 months. 5. Long-term graft survival continues to differ dramatically between Black and Caucasian recipients. Transplant half-lives were consistently 4 years among Black and 7.5 years among Caucasian recipients of first cadaver transplants. Even comparing HLA-identical sibling transplants, the late loss rate in Blacks was double that in Caucasians. 6. The transplant center was an important factor in the race effect. Blacks transplanted at centers with overall high success rates had 79% 1-year graft survival, not significantly lower than that of Caucasian recipients. As the overall success rates declined at good and fair centers, the difference in 1-year graft survival between Black and Caucasian recipients increased from 8% to 12%. 7. The transplant center did not influence long-term graft survival in Black recipients. Transplant half-lives ranged from 4.9-3.9 years at excellent and fair centers, respectively. 8. The difference in graft survival between Caucasian and Black donors was primarily a center effect. In transplants to Caucasian recipients, there was no difference between Caucasian and Black donors at excellent and good centers, and a 16% difference at fair centers.

Adolescent↗
PubMed1989

Early rejection episodes.

1. Early rejection episodes had an overriding effect on graft survival. One-year graft survival decreased by 18% in LRD transplants and by 27% in cadaver-donor transplants when rejection occurred. Early rejection-free patients had 96% (LRD) and 87% (cadaver-donor) 1-year graft survival. 2. Among rejection-free recipients of first cadaver transplants, 1-year graft survival decreased by 5% when function was delayed for 8-14 days and by 10% when function was delayed more than 14 days, suggesting some rejections were masked by early nonfunction. 3. Rejections occurred in 30% of first cadaver donor transplants overall and ranged from 9-50% at individual contributing centers. Rejections occurred in 27% of LRD transplants and 37% of cadaver retransplants. 4. Histocompatibility affected the frequency of rejection as well as subsequent graft survival. The lowest incidence of rejection was 17% in HLA-identical sibling transplants, followed by 0 HLA-B,DR mismatched first cadaver transplants, with a progressive increase to 34% in completely mismatched (HLA-B,DR) first cadaver transplants. Parent and 1-haplotype sibling donor transplants were intermediate with a 30% incidence of rejection. In first cadaver transplant recipients with rejection, graft survival decreased from 78-59% with the degree of HLA mismatch. 5. Pretransplant transfusions also reduced the rejection frequency from 42% without to 24% with more than 4 transfusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗
PubMed1988

Significance of the HLA molecular structure to transplantation.

1. Residues in the first, second, and third domains of HLA-A,B,C, and the first domain of DR beta, DQ alpha, and DQ beta molecule have been assigned to unique A,B,C or DR specificities from the known amino acid sequences. Antibodies were noted to correlate with most of these variable amino acid residues. 2. We therefore conclude that most of the variable residues in the first domain function as immunogens against which the antibodies had been elicited. 3. If the variants at these positions are immunogens, then it follows that matching for transplantation should be done by considering mismatched amino acids rather than the private specificities, as performed today. 4. Molecular matching cannot be performed immediately for the HLA-A,B,C specificities since many specificities are not yet sequenced. For the DR and DQ specificities, the sequences are established, but antisera identifying the subtypes of DR and DQ are only now becoming available. Once patients are typed for the 23 DR beta alleles, 8 DQ alpha alleles and 13 DQ beta alleles, matching should be feasible. 5. Molecular matching combines both public and private specificity matching since it assumes that both types of antigens are distinct. A single extended DR mismatch may involve as many as 76 amino acid residues of mismatch. 6. True cross-reactivity of the HLA molecules can eventually be established through structural studies. Most of the previously described "cross-reactivities" are likely to be shared determinants.

Amino Acid Sequence↗
PubMed1988

The transfusion effect.

1. There was a "transfusion effect" for cadaver kidney transplant recipients and the improvement of 1-year graft survival with transfusions was 7.1% (p0.0002) in 1987. 2. Two or 3 pretransplant transfusions are sufficient to obtain the maximum transfusion effect. 3. In 1988, about a quarter of the patients received first cadaver kidney transplants without any pretransplant transfusions, whereas only 10% were nontransfused during the period between 1981 and 1984. 4. The transfusion effect diminished as patients aged. The increase in 1-year graft survival with transfusions was 17% in patients aged 16-25, 4% in patients aged 46-55, and 1% in patients over 55. 5. Both transfused and nontransfused patients had as high as 83% 1-year graft survival rates when they received 0 A, B, DR-mismatched kidneys. Transfusions improved graft survival by as much as 8% for recipients with mismatched grafts. 6. There was no transfusion effect in recipients of 0 DR-mismatched kidney transplants. Transfusions improved the 1-year graft survival rate by 8-10% for transplant recipients with 1 or 2 DR-mismatched kidneys. 7. The transfusion effect was greater in black (8%) than white (4%) recipients; however, the 77% 1-year graft survival rate for transfused black recipients of 0 DR-mismatched kidneys did not differ from that of transfused whites. 8. Considering the transfusion effect on graft failure rather than graft survival, the failure rate in nontransfused patients could have been reduced by 30% in transplants performed between 1976 and 1979, 17% in transplants from 1980 through 1983, and 21% in transplants since 1984 with blood transfusions.

Adolescent↗
PubMed1988

Sensitization.

1. Sensitization increases the time waiting for a transplant. In Southern California, more than half the patients waiting more than 3 years are broadly sensitized. 2. First transplants in patients with greater than 50% PRA had 8% lower 1-year graft survival and retransplants in patients with greater than 10% PRA had 5-10% lower 1-year graft survival rates than nonsensitized patients respectively. 3. In sensitized recipients, 5-8% of kidneys that do not function in the early posttransplant period may be due to unrecognized antibody reactive to the donor. 4. The greatest risk of antibody-associated graft loss is in the first 2 weeks posttransplant. Some losses may be due to unrecognized hyperacute rejection though cellular rejection and other complications may be missed in the patient with a nonfunctioning graft. 5. Giving small numbers of blood transfusions reduces the risk of sensitization for never transplanted patients without significant loss of the beneficial transfusion effect. Transfusions following a graft loss should be avoided as they confer no benefit and significantly increase the likelihood of sensitization. 6. The effect of HLA matching on graft survival in sensitized and nonsensitized patients was the same. Matching for HLA-A and B antigens is influenced by sensitization through selection at the crossmatch. 7. More sensitive crossmatch tests should be carefully evaluated so that the price of improving early function and decreasing early graft loss is not condemning an excess of patients to a lifetime of dialysis.

Blood Transfusion↗
PubMed1988

Renal regrafts.

1. Approximately 15% of kidney transplants each year were regrafts. 2. One-year survival of cadaveric second transplants was 66.1% vs 75.9% for first transplants. One-year survival of second transplants from living donors was 82.7% vs 89.4% for first transplants. 3. The major difference between first and second transplants was from graft loss within the first month (14.1% for second transplants vs 6.5% for first transplants). 4. Patients younger than age 10 and older than 60 were poor candidates for regrafts. One-year graft survival was 46.1% and 51.7%, respectively. Patients 31-40 years old had a 1-year graft survival rate of 68.9%. 5. HLA-matched regrafts functioned better than mismatched grafts. A 4-antigen HLA-B,DR mismatch was associated with a decreased 3-month graft survival of 11.6% (p = 0.001 vs 0 mismatches). PRA levels or flow cytometry crossmatches may be better predictors of second graft outcome. Patients with PRA levels of 10-100% prior to retransplantation had a 6-7% lower 1-year graft survival than patients who never developed antibodies. 6. Patients with end-stage renal disease from diabetes had similar graft survival rates to patients with other diseases. Diabetes, however, was associated with a 2.9% higher death rate at 1 year (p = 0.03). 7. Parous females responded similarly to nulliparous female or male recipients. 8. Female donor regrafts were associated with an 8% lower 1-year graft survival rate when compared to kidneys from male donors. 9. Black donor regrafts to nonblack recipients were associated with a 13.8% lower 1-year graft survival. Black recipients had a 7% lower 1-year graft survival rate compared to nonblack recipients. 10. Regrafted patients benefited from preoperative transfusions only if they had never received blood products previously. 11. First graft survival less than 6 months was associated with a 5-15% lower second graft survival rate at 1 year. Thereafter, the graft failure rate was higher in patients whose first graft survived more than 6 months. By 6 or 7 years responders and nonresponders had equivalent graft survival. 12. Long-term graft survival may be adversely affected by CsA. 13. The optimum interval between first graft failure and regrafting was 1-6 months.

Actuarial Analysis↗
PubMed1988

Donor and preservation factors.

1. In nonsensitized, white recipients of first cadaver donor transplants, 1-year graft survival was: 13% lower when the donor was black than when the donor was white; 7-9% lower when the kidney was from a pediatric (under 15) or older (over 50) donor than from a donor aged 21-50; 8% lower when the donor was a female over 30 than when the donor was a male under 30; 4% lower when the cause of donor death was a cerebrovascular accident than when the death was a closed head injury; 6% lower when the kidney was transplanted with more than 36 hours of cold ischemia time than when ischemia was less than 24 hours; 3% lower if the kidney had been transported more than 50 miles to the transplant center. 2. The lower graft survival rates associated with the race, sex, age and cause of death of the donor were generally reflected in a higher incidence of early nonfunction and poorer quality of function. 3. Preservation related factors, long cold ischemia and sharing were associated with an increase in delayed onset of function, but there was no difference in the proportion of kidneys that never functioned during the follow-up period. 4. There was a 9% difference in 1-year graft survival between kidneys obtained from centers more than 50 miles from the transplant center and with more than 36 hours of cold ischemia and those transplanted locally with less than 24 hours of cold ischemia. 5. Long cold ischemia, even in excess of 48 hrs, had no effect on graft survival when the kidney was procured locally. Long cold ischemia in the absence of sharing was not an apparent risk factor. 6. Rather than concluding that distant sharing results in kidneys of poor quality, we may have to consider that kidneys of poor quality are sometimes shared. 7. Cadaver kidneys from female donors over 30 had 80% 1-year survival when transplanted to recipients who weighed between 41 and 75 kg, a result comparable to that obtained with young male donor organs. In recipients over 75 kg, survival of the older female kidneys was 70% vs 80% for young male donor kidneys. Recipient "size" may be a nonimmunological risk factor.

Adult↗
PubMed1988

Clinical transplants 1988. Overview.

1. The 3-month actual graft survival of 6-antigen matched transplants in the UNOS program was 96% compared to 85% in control kidneys which were not shipped (p = 0.004). Actuarial graft survival at 1 year was 89% for the 6-antigen matched kidneys and 78% for the controls (p = 0.02). 2. Several individual centers reported 1-year graft survival rates of 85-95% (in the first half of this volume). Various immunosuppressive protocols and attention to patient care resulted in high 10-year survival of 53% in 1 instance (Leuven). 3. The 1-year graft survival peaked at about 77% for transplants performed in 1985, 1986, and 1987. 4. Among transplants performed since 1984, HLA matching of cadaver donor transplants showed a 13% difference at 1 year between the best and worst A,B,DR matches, which expanded in 3 years to an 18% difference. 5. The center effect, which produces about a 13% difference in 1-year graft survival for cadaver donors, decreased to 0 in HLA-identical transplants. Thus, when the donor and recipient were histocompatible, all centers were able to achieve superior results. The results of the 6-antigen Match Study appear to validate this conclusion. 6. Preformed antibody is associated with a 9% decrease in graft survival for greater than 50% PRA in first grafts and 4% in second grafts. For peak antibodies, the difference was 7% for first grafts and 11% for second grafts. 7. Platelet flow cytometry in 23 patients with a positive flow cytometry crossmatch to T cells furnished a further refinement in grouping the patients. All 11 patients with a negative platelet crossmatch had functioning grafts at 1 month whereas only 5 of 12 patients with a positive platelet crossmatch had a functional graft at 1 month (p = 0.003). 8. The duration of first graft effect on the second graft has diminished considerably as immunosuppression improved. Patients whose first graft survived more than a year and who had a high 1-year graft survival of the second graft lost their second graft at an accelerated rate after the first year. At the end of 4 years, their survival was the same as that of the responder patients who had rejected their first grafts within 3 months. 9. False positive crossmatches, especially in "highly" sensitized patients were identified by the use of DTT. Transplants into 69 patients who were positive by the standard test but negative after DTT had a 94% 1-month function rate.(ABSTRACT TRUNCATED AT 400 WORDS)

Cadaver↗
PubMed1988

Blood transfusions and HLA matching--an either/or situation in cadaveric renal transplantation.

Cyclosporine-treated recipients of primary cadaver donor renal transplants had a one-year graft survival rate of 79% if they received pretransplant blood transfusions (n = 5308). The one-year survival rate for nontransfused recipients (n = 709) was significantly lower at 69% (P less than 0.001). The transfusion effect was larger in black recipients (a 17% difference) than in white recipients (5%). The effect was also larger in recipients of grafts poorly matched for HLA-A, B, -B, DR, or -DR antigens than in recipients of well-matched grafts. Transfusions did not significantly improve graft survival in recipients with zero or one HLA-A, B or -B, DR, or zero -DR-mismatched grafts. However, transfusions accounted for increases of 10%, 14%, and 17% in patients receiving grafts mismatched at 2, 3, or 4 HLA-B, DR antigens, respectively. Several factors including cyclosporine and HLA matching have contributed to improving graft survival rates in nontransfused recipients. Sensitization was noted in 20% of transfused patients awaiting primary renal transplants in Southern California, as compared with 10% in transplanted patients, suggesting a tendency to transplant nonsensitized patients. Of the sensitized patients, 75% were female. Based on these data, we suggest that high survival of primary kidney allografts in the cyclosporine era can best be maintained by the continued use of pretransplant transfusions for the majority of recipients--or, alternatively, by HLA matching for patients who are at higher risk of becoming sensitized.

Blood Transfusion↗
PubMed1987

Direct blood group typing of forensic samples using a simple monoclonal antibody assay.

A simple direct test for blood group antigens in samples of blood, dried blood, dried blood associated with fabric, semen, vaginal secretions, saliva and fingerprints is described. This test takes advantage of monoclonal antibodies which have been produced in this laboratory, but which are also becoming available commercially in ever increasing numbers. The test is sensitive and reliable as evidenced by its performance in blind studies of more than 700 blood samples. The test requires no special equipment and can be completed in 4 h. The test is sufficiently versatile that new antibodies can be added to the same test format as they become available.

Antibodies, Monoclonal↗