Progress in renal transplantation in Australia during 1975 to 1988

The survival of 4,525 cadaver grafts in non-diabetic recipients during 1975 to 1988 showed marked improvement for both primary and subsequent transplants in all age groups, particularly in the first 3 months after transplantation. The effect of recipient serum cytotoxic antibody reactivity on graft survival was strikingly reduced for most patients, particularly those with a first graft. HLA incompatibility at the combined B and DR loci exerted more influence on graft survival than at either individual locus. The reduction in graft loss was associated with adoption of elective transfusion, establishment of a national donor kidney exchange scheme, increasing use of polyclonal and monoclonal antibodies, and introduction of cyclosporine A (CsA). Redoubled efforts are required to prevent and overcome the restricted access of highly sensitized patients to the increasingly successful outcome of renal transplantation.