Clinical kidney transplants, 1988

• Published in: Immunology letters Vol. 21; no. 1; pp. 33 - 38
• Main Authors: Terasaki, P.I., Mickey, M.R., Cecka, M., Iwaki, Y., Cicciarelli, J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.1989
• Subjects: Cross-matching by flow cytometry; Cyclosporine; Effect of ABDR compatibility; Graft Survival; HLA-D Antigens - immunology; Human kidney transplants; Humans; Kidney Transplantation; Preformed antibodies; Survival rates; Effect of ABDR compatibility; Cyclosporine; Preformed antibodies; Survival rates; Cross-matching by flow cytometry; Human kidney transplants
• ISSN: 0165-2478; 1879-0542
• DOI: 10.1016/0165-2478(89)90008-4

1. 1.|The one-year graft survival rate of cadaver donor transplants has increased from about 40% in 1965 to almost 80% in 1988. Much of the improvement lies in the reduction of the one-month failure rates, which went down from one quarter in 1965 to 10% in 1988. 2. 2.|Kidneys that failed to function in the first month occurred in 5% of first graft patients without cytotoxins and increased to 9% if cytotoxins to more than 50% of the random panel were present. The non-function rate was 9% in regrafted patients without antibodies and double (18%) in those with a PRA of < 50%. 3. 3.|Some indication that the harmful antibodies can be detected by flow cytometry is provided by the fact that low graft survival rates resulted when transplants were done across a positive flow cytometry crossmatch in sensitized patients and in second graft recipients. In non-sensitized patients and in first graft patients, flow cytometry crossmatches against T cells were of no value. 4. 4.|The difference between first grafts, second grafts and transplants into sensitized patients disappeared when the grafts that did not function at one month were removed. 5. 5.|Cold ischemia time up to 36 hours had no effect on 1–3-year survival rates. Cold ischemia had relatively little effect even on delayed function in first transplants. However, in regrafts and in grafts into patients with preformed cytotoxins, increasing cold ischemia resulted in an increased incidence of delayed function. Yet, the one-year graft survival of those with delayed function was the same as those with immediate function. 6. 6.|Patients transplanted in 1983 showed no transfusion effect but those grafted in 1984, '85, '86 and '87 all showed a definite transfusion effect. Among those transplanted in 1987, the one-year graft survival was 70% for 671 patients with no transfusions and 77% for 2617 patients who had received transfusions. The magnitude of the effect is smaller than in the earlier experience, but it is sufficient to call into question the policy of avoiding transfusions. Three random transfusions provide the maximum effect, though even a single transfusion is effective. 7. 7.|Long-term survival was strongly influenced by histocompatibility matching. Among cyclosporine-treated patients, the three-year graft survival of zero ABDR-mismatched transplants was 79% as compared to 59% for the six antigen-mismatched grafts. 8. 8.|Large-scale national and international sharing of kidneys will be needed to obtain ideally matched transplants. In pool sizes of 8000 waiting patients, as many as 27% of the patients could obtain kidneys without a ABDR mismatch.