Kidney transplantation in highly sensitized patients: reappraisal of etiology, evaluation, and management protocols
The salient features of one-year regraft transplant survival are as follows: 1. The effect of cyclosporine is less (about 7% increase in one-year graft survival) on regrafted patients than on first grafts. 2. In general we saw a HLA antigen matching effect in cyclosporine- and noncyclosporine-treated retransplant patients. 3. Patients who received living-related HLA two-haplotype matched kidneys did equally as well as a first or regraft recipient. 4. Transfusions seemed to have a minimal effect on regraft survival. 5. It is more important to match in patients who have PRA and the matching benefits translate into 61% and 75% one-year graft survival for zero DR and zero B,DR mismatched regraft patients, respectively. 6. In regrafts, female donor kidneys resulted in 15% lower one-year graft survival than male donor kidneys. 7. Retransplant patients from fair centers showed a significant 13% increase in one-year graft survival with cyclosporine. 8. Cold ischemia time, diabetes, and kidneys used locally or shipped had little effect on the regraft one-year survival. 9. The initial function of the retransplant kidney had a very large effect on the final one-year graft outcome of that kidney and was independent of the use of cyclosporine patients having a functioning kidney at one month had 75% and 72% one-year regraft survival with and without cyclosporine treatment, respectively. Patients having a nonfunctioning kidney at one month had 5% and 8% one-year regraft survival with and without cyclosporine treatment, respectively. 10. Responder and nonresponder classifications as defined by the duration of the first graft resulted in a 10 to 15% difference in regraft survival. 11. The effect of HLA-A,B matching was very strong in responder patients, i.e., there was a 32% difference in one-year regraft survival between zero mismatch and more than two antigens of mismatch. In nonresponder patients, the effect of HLA-A,B matching was only 5%. For HLA-DR locus matching, the difference was 12% for responders and 6% for nonresponders. 12. Cyclosporine use showed about a 10% increase in graft survival in responders and nonresponders. 13. Responder classification was also possible by separating patients who had initial function but no function at one month (responders) from those with function at one month (nonresponders).