Five-year results of renal transplantation in highly sensitized recipients. Collaborative Transplant Study

A special program for the priority allocation of cadaver donor kidneys to highly sensitized patients was initiated 10 years ago. During the period from 1985 to 1994, 329 transplants were performed at 35 transplant centers. Five-year graft survival rates were: 59 +/- 4% for 156 first grafts, 52 +/- 5% for 133 second grafts, and 18 +/- 7% for 40 third or fourth grafts. The success rates of first and second grafts were comparable with the corresponding success rates of first and second cadaver transplants in non-sensitized recipients reported to the Collaborative Transplant Study. There was a highly significant impact of HLA matching on graft survival. Among first and second grafts, 35 transplants with no mismatches for HLA-B+DR had a 76 +/- 8% success rate at 5 years, compared with a 55 +/- 4% rate for 208 grafts with one or two mismatches and a 37 +/- 8% rate for 46 grafts with three or four mismatches (weighted regression P < 0.001).