Host presensitization and renal allograft success at a single institution: First transplants

From June, 1970, to January, 1975, 399 first transplants were performed at the University of Minnesota. Of these 399, 52 had performed antibodies against HLA antigens. When the results of transplantation to these recipients were compared with the results of transplantation to a recipient group matched for age, sex, presence of diabetes, time of transplant, and donor type, no differences were observed. Similarly, no differences were observed when either group of transplant recipients were compared with all first transplant recipients during this period of time. When the results were controlled for diabetes, related or cadaver donation, or degree of presensitization, no differences were observed. Four patients developed hyperacute rejection during this period of time. All four were found to have antibodies to the donor on retrospective analysis utilizing the most sensitive antiglobulin technique. In addition, 65 donor:recipient pairs negative by standard National Institutes of Health and cross-matching techniques proved to have positive prospective cross-matches utilizing the new antiglobulin technique. The correlation between the presence of anti-HL-A antibodies and negative antidonor cross-match and early kidney loss cannot be confirmed at a single institution. The results suggest that a highly sensitive antiglobulin cross-matching technique utilizing sera drawn just prior to the scheduled transplant and cross-matching utilizing the sera bearing the greatest number of anti-HL-A antibodies will eliminate correlation between anti-HL-A antibodies and early graft rejection in the presence of a negative cross-match.