Second transplants.

Abstract

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)