Influence of HLA matching on survival of second kidney transplants in cyclosporine-treated recipients

In an analysis of over 4000 cyclosporine-treated recipients of second kidney transplants we observed a strong effect of HLA matching in living-related and cadaver transplants. In contrast to the results obtained in first cadaver transplants, second cadaver transplants benefited substantially from matching for HLA-A locus antigens. The strongest effect of matching was found when HLA-A, HLA-B, and HLA-DR antigens were analyzed together: 214 second grafts with no mismatch had a survival rate of 82 +/- 3% at two years in contrast to a 49 +/- 4% rate in 149 grafts with 6 mismatches (P less than 0.0001, log rank). Patients whose first graft functioned for more than 1 year had a significantly higher second graft survival rate than patients with shorter first graft duration. Because the effect of HLA matching is particularly strong in patients with less than 1 year first graft duration, it is suggested that HLA well-matched kidneys should be allocated to them with priority.     

Correlation of HLA matching with kidney graft survival in patients with or without cyclosporine treatment

In a series of more than 8000 first cadaver transplants performed during a two-year period, 2198 recipients treated with cyclosporine had a higher graft survival rate (76 +/- 1% at 1 year) than 6392 recipients without cyclosporine (64 +/- 1%, P less than 0.0001). Matching for HLA-B plus HLA-DR resulted in a significant correlation with graft outcome, in patients with or without cyclosporine treatment (P less than 0.0001). Regardless of whether cyclosporine was used or not, grafts with 0 HLA-B,-DR incompatibilities had approximately 20% higher success rates at one year than grafts with 4 mismatches. A high (86 +/- 3%) graft survival rate was obtained in 161 cyclosporine-treated recipients with 0 HLA-B,-DR mismatches. Matching for the HLA-B and HLA-DR loci is shown to have an additive effect in cadaver kidney transplantation.     

Success rate and impact of HLA matching on kidney graft survival in highly immunized recipients

From 1985 to 1990, 225 highly immunized recipients were transplanted based on a program of serum exchange and priority allocation of kidneys to crossmatch negative recipients. The 1-year graft survival rate in first transplant recipients was 73% and in second transplant recipients, 71 %. Recipients of third or fourth transplants had a 25 % lower success rate. HLA matching exerted a significant influence on graft outcome. Twenty-five first or second grafts with zero mismatches for HLA-B,-DR had a 91 % 1-year survival rate, in contrast to a 58% survival rate of 38 grafts with of three or four HLA-B,-DR mismatches (log rank P < 0.001).     

Why do secondary cadaver renal transplants succeed? Results of the South-Eastern Organ Procurement Foundation prospective study, 1977-1982

We report the selective and therapeutic factors affecting multiple kidney transplant success from a prospective multicenter study of the South-Eastern Organ Procurement Foundation. From June 1977 to March 1982, 3,215 cadaver kidney transplants were performed at 39 institutions. There were 2,535 first, 564 second, 103 third and 13 fourth grafts. The actuarial graft survival rates at 1 and 2 years were 52 plus or minus 1 and 45 plus or minus 1 per cent, respectively, for first grafts, 44 plus or minus 2 and 40 plus or minus 3 per cent for second grafts, and 42 plus or minus 5 and 31 plus or minus 6 per cent for third grafts. Graft survival rates were significantly lower for second and third than for first transplants (p less than 0.003). There was no difference in patient survival rates. The data were analyzed to determine which selective and therapeutic variables governed success of primary and secondary grafts. Pre-transplant blood transfusions were associated with a significant increase in graft survival rates in primary (p less than 0.00005) and secondary transplants (p less than 0.01), and did not affect patient survival rates. The administration of antilymphocyte serum also improved graft survival rates significantly in primary (p less than 0.00005) and secondary grafts (p less than 0.00002), without alteration of patient survival rates. HLA compatibility improved primary graft survival rates (p less than or equal to 0.022) but this did not reach statistical significance in secondary graft survival rates. Second transplant graft survival rates were best when the primary graft functioned for more than 12 months (Breslow p less than or equal to 0.02) but were not related to the reason for loss of the first graft. Pre-transplant bilateral nephrectomy improved graft survival rates significantly but this phenomenon was linked to other treatment factors. No beneficial effect on graft survival rate could be shown after pre-transplant splenectomy in patients with primary or secondary grafts and this procedure was associated with reduced patient survival rates in both groups.     

Prolongation of long-term kidney graft survival by a simultaneous liver transplant: the liver does it,and the heart does it too

BACKGROUND: Whereas some authors reported that kidney transplants were protected from rejection by simultaneous liver grafts, other authors failed to obtain evidence for a kidney graft-protective role for the liver. METHODS: The survival rate of 383 kidney grafts in recipients of combined kidney-liver transplants performed between 1985 and 2000 and reported to the international Collaborative Transplant Study (CTS) was analyzed and compared retrospectively with that of a matched group of control patients who were transplanted with kidneys only. In addition, 105 combined kidney-heart transplants performed during the same time period were analyzed. RESULTS: At 1 year, the survival rate of kidney grafts in recipients of kidney-liver transplants was significantly lower than that in kidney only recipients (P<0.0001). Subsequently, however, kidneys in kidney-liver recipients fared much better so that the success rates were virtually identical after 8 years of follow-up (62.1+/-3.5% vs. 61.9+/-2.3%, P=ns). Half-life times after the first posttransplant year were 27.6 and 14.5 years for combined or single kidney grafts, respectively, and the projected 20-year graft survival rates were 46% and 35%, respectively. The 8-year survival rate of kidney grafts in recipients of combined kidney-heart recipients was 63.5+/-6.2%, the associated half-life time 31.6 years, and the projected 20-year graft survival rate 49%. CONCLUSIONS: The long-term kidney graft survival rate is higher in recipients of combined kidney-liver transplants than in recipients of kidney grafts only. Because the success rate is equally high in recipients of combined kidney-heart transplants, it is necessary to reexamine the hypothesis that the liver possesses a unique capacity of protecting a simultaneous kidney graft from rejection.     

Factors related to success or failure of second renal transplants.

From January 1, 1968 to December 31, 1973, 50 patients received two or more kidney transplants. Patient and graft survival was highly dependent upon the source of the donor and to a lesser extent the functional duration of the first transplant and the elapsed time between first and second graft. Survival (patient and graft) was best in patients receiving two related grafts and worst in patients receiving two sequential cadaver grafts. Intermediate rates of success followed cadaver transplantation after rejection of a related graft. The highest failure rate was encountered when those patients who sustained an early loss of the first cadaver graft received a subsequent cadaver graft within a few months. We recommended removal of the acutely rejected graft and delay prior to retransplantation of patients who rapidly reject cadaver grafts in the face of maximal doses of immunosuppression. A delay will permit recovery from both the immunosuppression and any underlying subclinical infections, and will permit the recognition of anti-HL-A antibodies which may not be manifest soon after rejection. Retransplantation of the patient who is slowly rejecting the first kidney does not require prior removal of the rejected graft or delay in retransplantation.     

Strength of HLA-A,HLA-B,and HLA-DR mismatches in relation to short- and long-term kidney graft survival

The separate influence of HLA-A, HLA-B, and HLA-DR mismatches on short- and long-term kidney graft survival was analyzed in a series of over 40,000 recipients of first cadaver kidney transplants. As expected, during the early posttransplant period, HLA-DR mismatches had a stronger influence on graft survival than HLA-B mismatches, and HLA-A mismatches had a very small influence. Surprisingly, during the period from 6 months to 5 years post transplantation, all three HLA loci had approximately the same influence. When the graft survival computation was started at 100 % at 6 months, the difference between grafts with zero or two mismatches at the end of 5 years was 6 %, regardless of whether HLA-A, HLA-B, or HLA-DR antigens were analyzed. The influence of the three loci was additive so that the survival rate difference between transplants with zero or six mismatches for HLA-A, -B, -DR was 17 % at 5 years. We concluded that, although the HLA-A locus exerts only a weak influence during the early posttransplant course, its influence on long-term survival is comparable to that of HLA-B and HLA-DR. In order to obtain optimal long-term survival, all three loci must be considered in the donor-recipient matching procedure.     

HLA matching and cadaver kidney transplant survival in North America: influence of center variation and presensitization.

In an analysis of 4,851 first cadaver kidney transplants, we found a statistically highly significant correlation between the number of HLA antigens mismatched and graft survival (P less than 0.0005 at 1 year). The difference in the survival rates of grafts with no HLA mismatch compared with grafts with four mismatches was 11 to 12%, similar to results of previous analyses. HLA-A locus antigens had a slightly stronger effect than B locus antigens. The correlation of HLA matching with graft survival was most significant at centers with poor overall transplant outcome, and there was no correlation at centers with very good overall results. Presensitization also had the strongest effect at centers with poor overall graft survival.     

Priority allocation of cadaver kidneys to highly presensitized transplant recipients

Within a prospective program of priority kidney allocation to highly presensitized recipients, 100 first and second cadaver transplants were performed from April 1985 to July 1987. The patient survival rate was 93% at 1 year. Graft survival at 1 year was 71% for first transplants and 68% for second transplants. There was a statistically significant correlation of graft outcome with matching for HLA-DR (P<0.02) and for HLA-B and -DR (P<0.02). The results demonstrate that multicenter cooperation is advantageous for the transplantation of highly presensitized recipients and that acceptable success rates can be obtained.     

Dominant effect of histocompatibility on ten-year kidney transplant survival

Using actuarial methods, factors influencing long-term graft survival were examined in 33,594 recent (since 1974) kidney transplants reported to the University of California, Los Angeles, Transplant Registry. One- and 10-year graft-survival rates as well as late (from 3 through 10 years) graft-loss rates (half-lives) were determined. The donor-recipient relationship had the greatest influence on long-term graft survival. Transplants between HLA-identical siblings had graft-survival rates of 89% at 1 year and 68% at 10 years, compared with 76% and 43% for parental donors, and 58% and 26% for cadaver donor transplants, respectively. These differences were also evident from the graft half-lives, which were 22 years for HLA-identical sibling, 12 years for parental, and 8 years for cadaver donor allografts. In cadaver donor transplants, matching for HLA-A,B antigens had the greatest influence on long-term graft survival, with a 15% 10-year graft survival (39% vs. 24%) and 7-year half-life (14 vs. 7 years) advantage seen with the best (zero HLA-A,B mismatches) compared with the worst (4 HLA-A,B) cases, respectively. Some of the factors studied, such as transplant number and pretransplant transfusions, tended to influence the short- rather than long-term graft-survival rates. Others, including HLA-A,B matching, early graft function and the recipient's original disease, influenced both early and late graft survival. Over all, histocompatibility between donor and recipient had by far the greatest influence on the long-term success of renal allografts.     

Enhanced kidney graft survival with retroplacental source gamma-globulin. Results of a 5-year prospective study at a single center

We examined the possibility that retroplacental source gamma-globulin (RPGG), with its content of anti-HLA antibodies, would improve cadaver kidney graft survival rates. In a 5-year controlled prospective study of 208 transplants, we found that the addition of RPGG to a standard immunosuppressive drug regimen (azathioprine and prednisone) resulted in significant improvement of the cumulative survival rate (CSR) of first and second grafts. At 2 years, the overall CSR of first grafts increased from a control value of 37% +/- 6 to 52% +/- 6 (P = 0.037). Among second graft recipients, the CSR increased from a value of 19% +/- 8 to 50% +/- 10 (P = 0.014). This improvement in graft survival was seen as early as 3 months after surgery and was sustained through 3 years without added recipient morbidity or mortality. When recipient populations were stratified for various factors, those groupings remonstrative of an intact or active humoral immune response capacity were found to have the highest survival rates in the study; 2-year graft CSRs of 70% +/- 6 and 65% +/- 10 were found in recipients with preformed antibody resulting from blood transfusions (P - 0.003) and cytomegalovirus infectivity (P = 0.0006), respectively. These findings indicate that the improved graft survival seen in this study may have resulted from a recipient's immunological response to challenge with RPGG.     

Repeat cadaver kidney transplantation using cyclosporine A immunosuppression

Repeat cadaver kidney transplantation using azathioprine immunosuppression carried a higher risk of graft loss than primary transplants. We analyzed the results of repeat cadaver kidney grafting with cyclosporine A immunosuppression. A total of 33 cyclosporine A-treated patients received the second kidney transplant at varying intervals after failure of the first transplant. Graft survival at 1 year was 66 per cent. A concurrent group of 189 cyclosporine A-treated first cadaver kidney recipients had a 1-year graft survival rate of 75 per cent, although this better result was not statistically significant (p greater than or equal to 0.25). A historical group of 31 azathioprine-treated second graft recipients had a significantly worse 1-year graft survival rate of 45 per cent compared to the cyclosporine A second graft group (p less than 0.1). Patient age, sex, early first graft loss, interval between transplants and the presence of panel reactive antibodies were not factors in predicting second graft outcome. A complete DR mismatch appeared to worsen the second transplant survival. These findings indicate that early graft survival of cyclosporine A-treated repeat cadaveric transplants is acceptable and is better than azathioprine-treated first or second grafts.     

Kidney retransplantation in the cyclosporine era

The results of kidney retransplantation in the cyclosporine era remain to be determined. Over a 42-month period, 76 nonprimary renal transplants (66 second, 7 third, 3 fourth allografts) were performed in 73 recipients under cyclosporine immunosuppression. The patient population was predominantly white (90.4%) with a mean age of 32.3 years. Twenty-one recipients (28.8%) were diabetic, and 36 (49.3%) were highly sensitized (panel-reactive antibody [PRA] greater than 50%). Sixty-two patients received cadaver donor grafts while the remaining donations were living-related (12) or living-unrelated (2). A sequential antilymphocyte globulin/cyclosporine protocol was employed, with cyclosporine therapy delayed until adequate renal function occurred. Overall patient and graft survival is 92.1% and 60.5%, respectively, after a mean follow-up of 20.0 months. The mean serum creatinine is 1.64 mg/dl in the 46 functioning allografts. Graft survival is 63.6% for secondary grafts, 28.6% for tertiary grafts, and 66.7% for fourth kidney transplants. In second transplants, recipients of cadaver donor kidneys have a graft survival of 58.5%, while living-related donor graft survival is 84.6% (P = 0.07). In the cadaver retransplant population, duration of previous transplant function greater than one year and HLA-DR matching were associated with increased graft survival, while age over 39 and presence of diabetes mellitus with reduced graft survival. However, these trends were not significant. Peak PRA above 50% did demonstrate a significant negative impact on graft survival both in the univariate and multivariate analyses of risk factors. Acute rejection occurred in 50 patients (65.8%), and was successfully reversed 50% of the time. Of the 30 grafts lost, 25 (83.3%) occurred within four months of retransplantation. Transplant nephrectomy was performed in 20 patients. Cyclosporine was not administered in 21 (70%) of these early graft failures, negating any potential beneficial effect. Retransplantation can be performed safely, with living-donor graft survival superior to cadaver retransplant rates. Rejection and early graft loss are common, especially in the highly sensitized patient. The impact of cyclosporine immunosuppression in renal retransplantation is much less dramatic than in primary transplantation in a protocol that delays cyclosporine therapy until allograft function is demonstrated.     

Long-term effect of splenectomy versus no splenectomy in renal transplant patients. Reanalysis of a randomized prospective study

In 1980 we determined the patient and renal allograft survival in 299 kidney transplants recipients who, between 1976 and 1979, were randomized to splenectomy (n = 146) versus nonsplenectomy (n = 152), and who were treated with antilymphocyte globulin-azathioprine-prednisone for immunosuppression. The preliminary analysis showed significantly (P less than .05) better (10% overall, 12% for cadaver, 14% for nonidentical-related) graft survival rates at two years in splenectomized recipients. The splenectomized patients had higher white blood counts and received more azathioprine and less prednisone. We concluded that splenectomy had a beneficial effect for at least the first two years posttransplant without a detrimental effect on patient survival. Splenectomy, however, remains controversial. Thus, we reanalyzed the original cohort 7 years after the study began and 4 years after the last patient was entered. The reanalysis showed that the differences in graft survival rates between splenectomized and nonsplenectomized recipients were no longer significant. There were more late deaths from sepsis in the splenectomized group, although the overall patient survival rates were similar in splenectomized and nonsplenectomized recipients. Splenectomy modestly improved graft survival for the first few years, but the eventual fate of the graft was determined by other factors. The dominant influence on graft survival rates was the source of the kidney (at 6 years in splenectomized recipients the functional survival rate of grafts from HLA-identical siblings was 24% higher than that of grafts from HLA-mismatched relatives, which in turn was 24% higher than that of grafts from cadaver donors; in nonsplenectomized recipients the difference in 6-year function rates between HLA-identical and mismatched related grafts was 34%, and between mismatched related and cadaver grafts was 16%. Between 1979 and 1983, we performed pretransplant splenectomies in all recipients of renal allografts from HLA-mismatched related or cadaver donors. Two-year graft survival rates were 81% and 68%, respectively, in azathioprine-treated recipients, 7% and 12% higher than in the splenectomized patients in the randomized trial. (ABSTRACT TRUNCATED AT 400 WORDS)     

Pancreas transplants from related donors

Of 89 pancreas transplants performed at the University of Minnesota between July 1978, and March 1983, 36 have been segmental grafts from living-related donors (17 HLA-identical siblings, 6 identical twins, 13 HLA-mismatched relatives). All recipients had been diabetic for at least 10 years and all donors were at least 10 years older than the ages of onset of diabetes in the recipients; in the case of sibling donors, no other siblings or family members other than the recipient were diabetic. Changes in plasma glucose and serum insulin levels occurred in most donors postoperatively, but glucose tolerance tests usually remained normal. Of the 36 grafts from related donors, 16 are currently functioning (12 were technical failures), as compared with 10 of 53 from cadaver donors (10 were technical failures). The pancreatic ducts were left open, injected with synthetic polymers, or anastomosed to a Roux-en-Y limb of recipient jejunum. All techniques have been associated with successes and failures, but we currently prefer the enteric-drainage technique. The patient survival rates for recipients of transplants from related versus cadaver donors were 94% versus 78% (P less than .013); the respective graft survival rates were 43% versus 20% (P = .25). When only technically successful grafts were considered, the one-year function rates were 65% for pancreas grafts from related donors (n = 29) versus 25% for those from cadaver donors (n = 43) (P = .005). The highest success rate has been in azathioprine-treated recipients of technically successful pancreas transplants from related donors of a previous kidney (3 of 3 grafts from HLA-identical siblings and 3 of 3 from HLA-mismatched relatives are functioning). However, 7 of 9 technically successful grafts from HLA-identical siblings in nonuremic, non-kidney-transplant recipients treated with cyclosporine are also functioning (one-year graft survival rate of 76%). The results in nonuremic, non-kidney-transplant recipients of mismatched related grafts have not been so good, and only one of 5 technically successful grafts in this category is currently functioning. However, this patient has been treated with cyclosporine, azathioprine, and prednisone (triple therapy)--an immunosuppressive regimen we have recently applied with success in nonuremic, non-kidney-transplant recipients of cadaveric grafts.(ABSTRACT TRUNCATED AT 400 WORDS)     

Renal transplantation between living-related sibling pairs matched for zero-HLA haplotypes

The functional survival rates of kidney grafts from zero-HLA haplotype-matched sibling pairs are similar to one-haplotype-matched pairs and superior to cadaver grafts. From January 1980 to March 1988, 318 primary renal transplants from sibling donors (151 matched for two, 130 for one, and 37 for zero HLA haplotypes), and 352 cadaver graft transplants were performed at the University of Minnesota. The renal graft survival rates at two years were 94%, 91%, and 94% for the 2, 1, and 0-haplotype pairs versus 75% for cadaver graft recipients (P less than 0.04). When analyzed across the different immunosuppression protocols the same trends held up, similar graft functional survivals for 1- and 0-haplotype-matched pairs both being superior to cadaver graft recipients. The graft functional survival rates at two years of recipients of 0-haplotype-matched sibling donor grafts (n = 37) was 94% versus 80% for recipients of cadaver donor grafts matched for greater than or equal to 4 HLA antigens. In addition, for recipients of 0-haplotype-matched grafts, hospital stay was shorter, fewer patients required dialysis posttransplant, and, despite a slightly higher incidence of rejection episodes (51% versus 40%, P = ns), the creatinine values one year posttransplant were significantly lower (1.5 mg/dl versus 1.9 mg/dl, P less than 0.02) than those of recipients of cadaver grafts matched for greater than or equal to 4 HLA antigens. These data support the use of cadaver grafts for patients not having a willing sibling donor, and the use of all willing sibling donors, whether or not they are a zero-haplotype match, for patients fortunate to have that family commitment.     

Calculations on long-term graft and patient survival in human kidney transplantation.

Long-term survival rates of human kidney transplants were found to decline at constant rates following the second year after transplantation. The slopes of decline were statistically significantly different for cadaver, parent-to-child, and HLA-identifical sibling transplants, resulting in graft survival half-life times during the constant risk phase of 7.5, 11, and 34 years, respectively. The corresponding patient survival half-life times were 12, 19, and 36 years, respectively. A highly significant difference in long-term survival risk was found when seven transplant centers that had been selected on the basis of their good 1-year graft survival results were compared with seven centers known to have a poor 1-year survival rate. The cadaver graft half-life times during the constant risk phase were 3.3 years for the "poor" centers and 8.7 years for the "good" centers. Thus, although histocompatibility obviously is a main factor in determining long-term survival risk, additional factors such as clinical treatment regimen appear to be influential. Knowledge of the long-term risk constants for the different transplant categories can be applied for the projection of success rates as well as retransplant and dialysis needs.     

Long-term survival following kidney transplantation in 100 type I diabetic patients

Between December 1966 and April 1978, 265 uremic patients with type I diabetes received primary renal allografts at the University of Minnesota. One hundred of the diabetic patients were alive with a functioning graft 10 years after transplantation. The actual 10-year patient and primary graft functional survival rates overall were 40% and 32%, respectively. For recipients of HLA-identical sibling (n = 45), mismatched living-related (n = 121), and cadaver donor grafts (n = 99), the actual 10-year patient survival rates were 64%, 33%, and 36%, respectively, and the actual 10-year graft functional survival rates were 62%, 28%, and 22%, respectively. The differences in patient and graft survival rates between HLA-identical graft recipients and recipients of mismatched related and cadaver grafts were significant (P less than 0.001). Of the 100 patients who survived into a second decade, at 15 years posttransplant 51% were alive, and 41% had functioning grafts. For recipients of HLA-identical sibling, mismatched living-related donor grafts, and cadaver donor grafts who survived 10 years, 47%, 57%, and 43%, respectively, were alive at 15 years, and 31%, 45%, and 43%, respectively, had functioning grafts. For recipients who made it to the second decade, patient and primary graft survival rates thereafter were not statistically different by donor source. Twenty-three patients died in the second decade after transplantation, 10 of cardiovascular disease. Twenty-five patients lost graft function in the second decade, 19 from death with a functioning graft. In regard to diabetic complications, recurrence of diabetic nephropathy was common, but only two patients lost graft function solely for this reason. In 21 patients (42 eyes) followed prospectively for 10 years, visual acuity deteriorated in 26%, was stable in 64%, and improved in 10% of eyes. Neurophysiological test results indicated that correction of uremia does not stop the progression of diabetic neuropathy in recipients of kidney transplants alone. Even without cyclosporine, nearly two-thirds of recipients of HLA-identical kidney grafts, more than one-quarter of recipients of mismatched living-related donor grafts, and more than one-fifth receiving cadaver grafts enjoyed an extension of life for more than 10 years.     

Living unrelated donor kidney transplantation

BACKGROUND: Living unrelated donors remain an underutilized resource, despite their high graft survival rates. In this article, we updated the long-term results of more than 2500 living unrelated donor transplants performed in the United States. METHODS: Between 1987 and 1998, 1765 spouse, 986 living unrelated, 27,535 living related, and 86,953 cadaver donor grafts were reported to the United Network for Organ Sharing Kidney Registry. Kaplan-Meier curves compared graft survival rates in stratified analyses, and a log-linear analysis adjusted donor-specific outcomes for the effects of 24 other transplant factors. RESULTS: The long-term survival rates for both spouse and living unrelated transplants were essentially the same (5-year graft survivals of 75 and 72% and half-lives of 14 and 13 years, respectively). The results were similar to that for parent donor grafts (5-year graft survival = 74% and half-life = 12 years) and were significantly (P = 0.003) better than cadaver donor grafts (5-year graft survival = 62% and half-life = 9 years). After adjusting for the presence of transplant factors known to influence survival rates, recipients of living unrelated donor kidney transplants still had superior outcomes compared with cadaver transplants. CONCLUSIONS: Living unrelated kidney donors represent the fastest growing donor source in the United States and provide excellent long-term results. Encouraging spouses to donate could remove nearly 15% of the patients from the UNOS waiting list, effectively increasing the number of available cadaveric organs.     

Delayed graft function does not influence long-term outcome in cadaver kidney transplants without mismatch for HLA-DRB1

The currently study focused on the influence of delayed graft function on the long-term graft success rate in cadaver kidneys without any mismatches for HLA-DRB1. Donor-recipient HLA-DRB1 was determined by the significant two-locus linkages of HLA-B and-DRB1. The overall 5-year graft success rate was 88% in an HLA-DRB1-compatible group, significantly higher than the 69% in an HLA-DRB1 mismatch group (P<0.05) and the 66% in an HLA-DR mismatch (P<0.01). Delayed graft function was observed in 182 of 223 transplants. This high incidence of 82% is due to the fact that, in Japan, kidney procurement may only occur after cardiac arrest. The incidence did not differ in eaach group. The 5-year success rate for grafts with delayed function was 87% in the HLA-DRB1-compatible group, again significantly superior to the 68% in the HLA-DRB1 mismatch group and the 63% in the HLA-DR mismatch cases (P<0.05). There was, thus, no difference in graft success rate for each group, with or without delayed graft function. Consequently, we feel that delayed graft function has no impact on the long-term outcome in transplants without mismatches for HLA-DRB1.