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Clinical kidney transplants, 1988.

P I Terasaki1, M R Mickey, M Cecka

  • 1Department of Surgery, U.C.L.A. School of Medicine.

Immunology Letters
|April 1, 1989
PubMed
Summary

Kidney transplant survival has significantly improved due to reduced early graft failure. Early non-function rates are higher in patients with pre-existing antibodies and in regrafted patients, especially with longer cold ischemia times.

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Significant HLA matching effect in a large urban transplant center composed primarily of minorities.

Transplantation proceedings·2005

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Surgical Outcomes

Background:

  • Cadaver donor kidney transplant survival has dramatically improved over recent decades.
  • Early graft failure (within one month) significantly impacts long-term transplant success.
  • Patient sensitization and prior transplant history influence early graft function.

Purpose of the Study:

  • To analyze trends in cadaver donor kidney transplant survival rates.
  • To identify factors contributing to early graft non-function.
  • To evaluate the utility of flow cytometry crossmatching and cold ischemia time.

Main Methods:

  • Retrospective analysis of historical transplant data (1965-1988).
  • Comparison of graft survival and early non-function rates based on patient sensitization, antibody presence (cytotoxins, PRA), and transplant history (first vs. regraft).
  • Assessment of flow cytometry crossmatch results and cold ischemia time in relation to graft outcomes.

Main Results:

  • One-year graft survival increased from 40% (1965) to 80% (1988), with reduced one-month failure rates (25% to 10%).
  • Early non-function rates were elevated in patients with cytotoxins (9%) and in regrafted patients (18% with PRA < 50%).
  • Positive flow cytometry crossmatches correlated with lower survival in sensitized and regrafted patients; cold ischemia up to 36 hours had minimal impact on first grafts but increased delayed function in regrafts and sensitized patients.

Conclusions:

  • Improvements in early graft function are key to enhanced long-term kidney transplant survival.
  • Pre-transplant antibodies and prior transplant status are critical factors for early graft outcomes.
  • Flow cytometry may aid in identifying high-risk patients, while cold ischemia time is more critical for regrafts and sensitized recipients.

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