Regrafts

1. Retransplant survival rates have been increasing at a much faster rate than those of first transplants. The difference between first and second transplant 1-year survival rates has decreased from 8% in 1988 to 2% in 1991. 2. Second transplant recipients given 1-20 pretransplant transfusions had 3-5% higher graft survival rates than nontransfused patients or those given more than 20 transfusions. Transfusions for first or multirenal transplants had no significant impact on survival and in some cases, nontransfused patients had higher graft survival rates. 3. The duration of previous graft survival remains one of the best indicators of how subsequent grafts will survive. The 1-year regraft survival rate for second transplant recipients was 77% when the first transplant had survived longer than 1 year, 69% when first graft survival was 6 months to 1 year, and 60% when first graft survival was less than 3 months (p < 0.005, each comparison). 4. The HLA-DR1 phenotype was associated with higher graft survival than patients lacking HLA-DR1. The difference was 8% at 1 year for second graft recipients (p < 0.001) and 15% for multiply retransplanted patients (p = NS). 5. Repeating an HLA-A or -B locus antigen mismatch from a previous graft had no apparent effect on regraft survival rates. Repeating an HLA-DR locus antigen mismatch, either alone or in combination with other antigens, resulted in a 5-8% decrease in 1-year regraft survival. Although the difference was not statistically significant at 1 year, survival was significantly lower at 2 and 3 years for recipients with repeated HLA-DR antigen mismatches.