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J M Cecka

Publications and source records attributed to J M Cecka.

At least 19 recordsLinked to original sources
PubMed1992

Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.

BACKGROUND: The importance of HLA histocompatibility typing to the outcome of transplantation of cadaveric kidneys has been controversial. Four years ago, a prospective trial began in all U.S. transplantation centers to determine whether the results of transplantation would improve with the nationwide shipment of kidneys from cadaveric donors to waiting patients undergoing dialysis when there was a match at the HLA-A, B, and DR loci. METHODS: A total of 1386 cadaveric kidneys were shipped from 108 organ centers to 198 transplantation centers and distributed among HLA-matched recipients, 1004 of whom were receiving a first transplant and 382 of whom were receiving a subsequent transplant. Graft survival in these recipients was compared with that in 22,188 recipients of first transplants and 3950 recipients of subsequent transplants whose HLA antigens differed from those of the donor. RESULTS: The rate of graft survival at one year in recipients of HLA-matched first transplants was 88 percent, as compared with 79 percent in the recipients of mismatched grafts (P less than 0.001). The estimated half-life of the kidney after the first year was 17.3 years for matched grafts, as compared with 7.8 years for mismatched grafts (P = 0.003). Among paired kidneys from 470 donors, one-year graft survival was 87 percent in the recipients of matched first grafts, as compared with 80 percent in the recipients of the contralateral kidneys, who did not have HLA matches with the donors. In donors and recipients matched for the more highly defined split Class I and Class II HLA antigens, the rate of graft survival after one year was as high as 90 percent. CONCLUSIONS: The collaborative renal-transplantation program for HLA matching of donors and recipients yielded an increased rate of one-year graft survival and an estimated half-life for matched grafts twice that for mismatched grafts. An increased role for HLA matching in kidney allocation is therefore indicated.

Adolescent↗
PubMed1992

Analyses of the UNOS Scientific Renal Transplant Registry at three years--early events affecting transplant success.

The success of cadaveric renal transplants in the first year is determined largely by events that transpire during the transplant hospitalization. This conclusion is based upon analyses of data on 19,525 cadaver donor renal transplants performed since October 1987 and reported to the UNOS Scientific Renal Transplant Registry from more than 200 centers nationwide. Graft survival rates at 1 year differed by 20-30% depending upon whether or not the transplanted kidney functioned immediately and upon whether the patient required dialysis during the first week posttransplant, experienced rejection, or was discharged with a kidney that was functioning well. Recipients whose discharge serum creatinine level was less than 2.6 mg/dl or whose graft was functioning well at the time of discharge had 88% 1-year graft survival. A multistep logistic regression analysis showed cold ischemia time, transfusions, donor age and cause of death, HLA-DR mismatches, and peak sensitization to be significant factors in the first week. Prophylactic antilymphocyte antibodies (ALG/OKT3) reduced the incidence of rejection from 30% to 20% during the transplant hospitalization, but apparently only delayed rejection. By 6 months there was only a 3% reduction with ALG and a 5% reduction with OKT3 in the incidence of reported rejection and a 2% difference in 1-year graft survival. Although graft and patient survival are important measures of transplant success, graft survival is predicted upon both early and late events. The course of the transplant during the initial hospitalization and the quality of function at discharge were the strongest determinants of 1-year graft survival.

Adolescent↗
PubMed1992

The UNOS Scientific Renal Transplant Registry.

1. One-year graft survival rates were 80%, 74%, and 66% for recipients of first (27,755), second (4,263), and multiple (914) cadaveric renal transplants, respectively. The 1-year patient survival rate was 94% for recipients of first or second grafts and 92% for multiply retransplanted patients. Half-lives projected for all cadaver transplants surviving the first year were approximately 8 years. 2. One-year graft survival rates were 95% for recipients of HLA-identical sibling-donor transplants (1,493), 91%, 90%, and 89% for recipients of 1-haplotype-matched sibling (1,787), parent (2,118), and offspring (715) donor grafts, respectively. One-year patient survival was 94% for parents receiving transplants from their children and 98% for all other recipients of kidneys from immediate family members. Projected half-lives were 26 years for HLA-identical grafts and 12-14 years for 1-haplotype-mismatched transplants from living related donors. 3. There were 181 transplants between spouses, with a 1-year graft survival rate of 92% and 99% patient survival. There were also 369 transplants from distant relatives or unrelated living donors with a 1-year graft survival rate of 86% and 95% patient survival. Projected half-lives for these transplants were 13 years. 4. Rejection episodes that occurred during the initial transplant hospitalization were reported in 24% of first and 33% of retransplanted recipients (p < 0.001). Rejection-free patients had an 85% 1-year graft survival rate compared with 67% and 58% in recipients of first or regrafts after early rejection (p < 0.001). Rejection episodes were strongly associated with histoincompatibilities. Among HLA-identical sibling transplants, 6% had early rejection compared with 12% of HLA-A,B,DR-matched cadaver transplants, 25% of parent-donor transplants and 28% of HLA-DR-mismatched cadaveric transplants. 5. The serum creatinine level (SCr) reported at the time of discharge was predictive of graft survival in both the short and long term. Recipients of first cadaver transplants discharged with SCr below 1.6 mg/dl (8,960) had a 91% 1-year graft survival rate and a projected half-life of 12 years, while those with SCr above 3.5 mg/dl had 49% 1-year graft survival and 5.3-year projected half-life (p < 0.001). Discharge SCr was significantly influenced by the recipient's weight, the donor's age, and the cold ischemia time.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Center effect in the UNOS Renal Transplant Registry.

Based upon univariate and multivariate analyses of transplant center effects: 1. Among the 115 centers selected for these analyses, there was no correlation between 6-month graft survival rates and half-lives projected for grafts surviving 6 months. 2. There was no significant center effect for living-related donor transplantations. 3. Centers that had the poorest short- and long-term survival performed more cadaveric transplants with patients in poor health at the time of transplant, more often transplanted a recipient other than the one originally identified for a particular kidney, and more often transplanted kidneys with prolonged cold ischemia, and kidneys from pediatric (age 0-11) donors, older (ages over 50) donors, Black donors, or donors who died with cerebrovascular accidents. 4. After adjusting for 17 potentially confounding variables, the difference between the best and worst center groups was the second most detrimental factor (following broad sensitization) in the first 6 months and was the factor ranked ninth in long-term survival. 5. The transplant year has emerged as a significant factor in long-term survival. This suggests that the late loss rate for transplants performed after 1988 may be diminishing. 6. The health status of the patient at the time of transplant was the dominant factor affecting long-term survival. 7. The choice of outcome variable and the selection criteria used in center classification affect the magnitude of the center effect and its relationship to other significant variables that influence graft outcome.

Adolescent↗
PubMed1992

Disease effects and associations.

1. The most common disease leading to end-stage renal disease were IDDM for Whites (36%), hypertensive NS for Blacks (26%), and CGN for Hispanics (35%) and Asians (47%). These racial differences should be taken into account in analyzing outcomes with respect to disease. 2. Differences in graft survival associated with different primary diseases were more apparent among Whites than Blacks. Race, rather than disease, was the dominant factor. 3. One-year graft survival was consistently highest for patients with IgA nephropathy (87%) and poorest for patients with SLE (78%). The difference across the spectrum of original diseases was significant (p < 0.001). 4. About 84% of White diabetics and 90% of those under age 50 had an HLA-DR3 or 4 tissue type compared with 50% of White donors (p < 0.001). The 1-year graft survival rate was 80% for DR3 or 4 IDDM patients and 74% for non-DR3/4 patients (p < 0.001). Black IDDM patients also had a significantly increased frequency of DR3 and 4 compared with Black donors (46% vs 32%, p < 0.001) and a similar trend toward higher graft survival, although the difference was not significant. 5. Of Whites transplanted with SLE, 60% had HLA-DR2 or 3 compared with 47% of donors (p < 0.001) and those with DR2 or 3 had significantly higher 1-year graft survival rates. Similar trends were noted for Blacks with SLE. 6. HLA-DR2 was present in 46 of 72 patients (64%) transplanted for Goodpasture's syndrome, compared with 28% of donors. Despite the small numbers, 1-year grafts survival was significantly better in the HLA-DR2 group (p = 0.006). 7. Significantly higher graft survival rates were observed among patients with HLA-DR1 in non-HLA-DR-associated diseases (CGN, IN, NS, or PC) but not in HLA-DR-associated diseases such as IDDM and SLE. 8. There were significant differences in recipient age and sex distributions in the major disease groups. Blacks under age 50 had significantly poorer outcomes than comparable Whites. 9. Pretransplantation health status influenced graft outcome in all disease groups. Patients with IDDM or NS were generally less healthy and correspondingly more debilitated than patients with other diseases. 10. Diabetic given a simultaneous kidney-pancreas transplant had 83% 1-year graft survival compared with 78% for those given a kidney alone (p < 0.001).

Adolescent↗
PubMed1992

Preservation.

1. There were no significant differences in 1-year graft survival rates comparing kidneys stored with 3 commonly used cold storage solutions (Collins', EuroCollins, and University of Wisconsin) over the past 12 years, even though preferences have changed sharply. 2. No significant differences in 1-year graft survival rates were noted when comparing kidneys preserved by pump perfusion and those maintained by simple cold storage. The lower incidence of delayed graft function for pump-preserved kidneys was at least partly attributable to a center effect. 3. Prolonged cold ischemia time (CIT) was associated with an increase in delayed onset of function. Of 2,718 kidneys transplanted within 24 hours, 21% did not function well within the first week. The fraction increased to 28% and 33% of kidneys transplanted between 25 and 36 hours (n = 1,858) and after 36 hours (n = 955), respectively (p < 0.01). One-year graft survival rates were 82%, 78%, and 76% for kidneys transplanted within 24 hours, between 25 and 36 hours, and after 36 hours, respectively (p < 0.01, each comparison). 4. HLA matching neutralized the impact of prolonged CIT completely. One-year graft survival was more than 86% in 715 recipients of 0 HLA-mismatched kidneys, regardless of CIT. For recipients of mismatched transplants, survival decreased by 5-6% as CIT increased from less than 24 to more than 36 hours (p < 0.01). Of the mis-matched kidneys with less than 24 hours CIT, up to 83% survived at 1 year compared with 87% of matched kidneys with more than 36 hours CIT (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Rejection episodes.

Based upon analyses of 40,671 kidney transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and August 1992: 1. Twenty-four percent of the 21,923 recipients of first cadaver grafts experienced one or more rejection episodes during their transplant hospitalization, 52% during the first 6 months. At 12 months, only 40% of patients remained rejection-free. Patients who experienced any rejection during the first 6 months had a 72% 1-year graft survival rate compared with 95% for those who remained rejection-free (p < 0.001). 2. Recipients of transplants from living donors had a significantly lower incidence of rejection episodes. There was a clear effect of histocompatibility in comparing the incidence of rejection in HLA-identical sibling transplants (8% at discharge and 32% at 1 year) with that in 1-haplotype disparate transplants (22% at discharge and 52% at 1 year, p < 0.01 at each time point). Rejections were reported for 25% of transplants from other living donors at discharge and for 56% at 1 year, similar to the figures for cadaver transplants. 3. Histocompatibility also influenced the incidence of rejection in first cadaver-donor transplants. Only 15% of recipients of 0-HLA-A,B mismatched kidneys had rejection episodes reported at discharge, compared with 26% of those who received kidneys completely mismatched for HLA-A,B antigens (p < 0.01). At 1 year, 56% of HLA-A,B matched patients remained rejection-free, whereas only 35% of those mismatched for 4 antigens had no reported rejection through the first year (p < 0.01). Considering HLA-DR antigen mismatches, 19% of the 0-antigen mismatched group had rejection episodes at discharge, versus 28% for those with 2 HLA-DR mismatches (p < 0.01), and at 1 year, the percentage who were rejection-free decreased from 48% to 40% and 34% with 0, 1, and 2 HLA-DR mismatches, respectively. 4. The incidence of rejection episodes decreased as the recipient's age increased. Patients under age 16 had the highest incidence prior to discharge (28%) and at 1 year (70%) compared with 17% and 47% at the same intervals in patients over age 60 (p < 0.01). 5. The donor's age also had a significant effect on rejection episodes. Transplants from pediatric and older donors had a higher incidence of reported rejections than those from donors aged 16-30, especially after hospital discharge.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Kidney allocation under the UNOS point system: an update.

1. The 1,480 patients awaiting cadaveric renal transplants at 14 Southern California transplant centers as of December 3, 1992, were compared with patients transplanted using a point system for one kidney and a hospital-based allocation for the second, or the current system allocating all locally procured kidneys by the point system with regard to several demographic parameters. 2. Of 1,472 waiting patients with sensitization data, 8.5% were broadly sensitized (> 80% PRA). Of the 737 kidneys allocated by the point system, 7% went to broadly sensitized patients, compared with 3% of 438 kidneys allocated by the hospitals (p < 0.001). 3. Of 1,470 waiting patients with information available, 23% were awaiting a repeat transplant. Under the point system, 18% of kidneys were used for repeat transplants compared with 9% of hospital-allocated kidneys (p < 0.001). 4. Of 1,434 waiting patients where the time waiting was available, 26% had waited 1-2 years, 12% 2-3 years, and 6% more than 3 years. Under the point system, patients waiting longer received significantly more kidneys than those recently added to the list: 35% had waited 1-2 years, 21% 2-3 years and 14% more than 3 years (p < 0.001). Kidneys allocated by the hospitals were transplanted to patients in approximately the same proportions as the waiting list: 29% to those waiting 1-2 years, 10% 2-3 years, and 3% more than 3 years. 5. Racial distribution of recipients was not significantly different under either allocation system from that of the waiting list. Whites comprised 39% of waiting patients, the same as the population of Los Angeles County.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗
PubMed1991

The UNOS Scientific Renal Transplant Registry--1991.

Based upon data reported to the UNOS Scientific Renal Transplant Registry between October 1987 and November 1991: 1. One-year graft survival rates were 79%, 73% and 62% for recipients of first (20,864), second (3,217), and multiple (673) cadaver donor transplants, respectively. 2. One-year graft survival rates were 94%, 89%, and 90% for first transplant recipients of kidneys from HLA-identical siblings (970), parents (1,487), and 1-haplotype-mismatched siblings (1,206), respectively. 3. Half-lives calculated after the first year were 7 years for cadaver donor transplants, 11 years for parent, 12 years for 1-haplotype sibling and, 27 years for HLA-identical sibling-donor first transplants. 4. The 1-year first transplant survival rate has improved from 78% in 1987-88 to 80% in 1990-91 transplants (p = 0.001). There has been an attendant decline in the percentage of broadly sensitized patients transplanted from 15% in 1987 to 8% in 1990 (p less than 0.01), which may have contributed to rising survival rates. 5. There has been a remarkable improvement in the 1-year graft survival of retransplanted patients from less than 70% in 1987-88 to 78% in 1990 (p less than 0.001). This improvement has been most notable in broadly sensitized patients and those with delayed graft function. 6. Diabetics who received a pancreas and kidney transplant (995) had 81% 1-year graft survival compared to 77% for those who received a kidney transplant only (p less than 0.002). 7. One-year graft survival rates decreased significantly in recipients of kidneys from donors aged under 16 or over 45. Survival was less than 70% when the donor was under 5 or over 60 compared to 81% when the donor was aged 16-45 (p less than 0.001) for recipients of first cadaver transplants. Delayed graft function occurred in 40% of cases when the donor was over 60 and 28% of cases when the donor was under 5. When function was delayed, survival was 50% for these marginal kidneys compared to 68% for younger adult kidneys with delayed function (p less than 0.001). Rejection also had a greater impact on survival of kidneys from donors under 5 or over 60. 8. The 1-year graft survival rate for 2,504 first transplant recipients of cadaver kidneys from young male victims of traffic accidents was 85%. The 1-year graft survival of 2,670 patients given kidneys from older female donors who died of cerebrovascular accidents was 73% (p less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Center effects in renal transplantation.

1. One-year graft survival rates for first cadaver transplants to adult recipients ranged from 60-93% at transplant centers reporting more than 50 transplants to the UNOS Renal Transplant Registry between October 1987 and December 1991. 2. There was no apparent correlation between center size and success rates for primary or repeat cadaveric transplants when centers were grouped according to high, average, and low 1-year graft survival rates. 3. Fifteen "high" centers had 88%, 15 "average" centers had 80%, and 15 "low" centers had 69% 1-year graft survival rates, respectively. 4. Projected half-lives for transplants surviving the first year were not significantly different among the 3 center groups, suggesting that long-term survival did not correlate strictly with 1-year survival. 5. The 20% difference in 1-year graft survival rates between the high and low center groups was reduced to 10% and to 5% when transplants functioning at discharge or at 6 months, respectively, were considered. Thus, approximately half of the center effect was associated with events that occurred during the transplant hospitalization. 6. At high and average centers, less than 10% of kidneys did not function on the first day compared with 17% at low centers (p less than 0.01). Twenty percent of patients at high and average centers required dialysis during the first week compared with 37% at low centers (p less than 0.01). Less than 5% of kidneys never functioned during the transplant hospitalization at high and average centers compared with 10% at low centers (p less than 0.01). 7. Graft survival rates for patients with early graft dysfunction were significantly higher at high centers than at average or low centers, suggesting that successful management of patients with poor early function differed among the center groups. 8. Low centers transplanted more Blacks and fewer healthy patients than high centers, but when stratified for these variables, the center differences in graft outcome were undiminished. 9. Other patient mix variables, including age, sensitization, and original disease, did not account for variation in survival rates for the center groups. High centers transplanted more diabetics (33%) than average (25%) or low (18%) centers. 10. There were no significant differences among the center groups in the incidence of early rejection episodes. However, graft survival following rejection was 10-30% lower at average and low centers than at high centers.(ABSTRACT TRUNCATED AT 400 WORDS)

Cadaver↗
PubMed1991

Sex and age effects in renal transplantation.

1. Since 1985, 1-year graft survival in first cadaver transplants has remained constant at 78-80%. One-year graft survival rates for recipients over age 50 improved with CsA from 58% in 1981-82 to 78% in 1985-86. Survival in recipients under age 10 was 70% from 1985 to 1988, but improved to 75% in transplants performed in 1989-90. 2. The percentage of immunologic failures decreased from 75% in recipients aged 1-10 to 54% in recipients aged over 50. Thirty percent of males aged 1-10 had rejection episodes during the transplant hospitalization compared with 15% of males over age 50. These findings support earlier studies suggesting young recipients have a stronger immune response. 3. The incidence of nonimmunological failures increased from 10% in recipients under age 30 to more than 30% in patients over age 50. 4. There were no significant differences in graft outcome associated with the recipient's sex. 5. Kidneys from donors aged 1-10 or over 50 yielded poorer results than those from adult donors aged 11-50. This donor age effect was most notable in broadly sensitized, retransplanted, or HLA-B,DR-mismatched recipients. 6. Discharge serum creatinine (SCr) levels over 2.5 mg/dl were reported for more than 40% of recipients given kidneys from donors under age 5 or over age 50. When the discharge SCr was less than 2.5 mg/dl, 1-year survival was 90%, regardless of the donor age. 7. Trauma deaths accounted for 90% of kidneys from male donors aged 15-30 and 70% of comparable aged female donors. Cerebrovascular accidents were the cause of donor death for 43% and 68% of kidneys from male and female donors over 30, respectively.

Adolescent↗
PubMed1991

Race effects.

1. One-year graft survival rates for cyclosporine-treated first cadaver donor transplants were 80% for 14,911 White recipients, 74% for 3,845 Blacks, 84% for 951 Asians, and 81% for 1,319 Hispanics reported to the UCLA Renal Transplant Registry between January 1984 and December 1991. 2. One-year graft survival rates for similar transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and December 1991 were 83% for 10,518 Whites, 79% for 3,655 Blacks, 82% for 429 Asians, and 84% for 1,277 Hispanic recipients. 3. Transplant half-lives calculated after 6 months were 10 years for Asian recipients, 9 years for Whites, 6 years for Hispanics, and 4 years for Black recipients (UCLA Registry). 4. Patient survival was 93% and 85% at 1 and 3 years, respectively, for both Black and White recipients of first cadaver transplants. Patient survival was 94% and 89% at 1 and 3 years, respectively, for Asian and Hispanic recipients (UCLA Registry). 5. Asian recipients had significantly better graft survival than Whites (4% through 3 years, p less than 0.05). This high survival was not affected by donor race, although HLA-matching was remarkably better in Asian-to-Asian combinations than White-to-Asian, nor by whether the transplant was performed in the United States or Canada, or at other international centers (UCLA Registry). 6. The poor graft survival of Black recipients at 1 and 3 years was strongly influenced by age-dependent factors. Black recipients of either sex aged 16-30 had the poorest graft survival rates (UCLA Registry). 7. Blacks were sensitized more often than Whites (17 vs 15%, p less than 0.01). Even moderate sensitization reduced 1-year graft survival from 76% to 71% (p less than 0.05) in Blacks whereas there was no effect in recipients of other races. By contrast, broad sensitization did not affect 1-year graft survival in Hispanic recipients (UCLA Registry). 8. Blacks received more poorly HLA-matched transplants than recipients of other races. Only 2% received HLA-A,B-matched kidneys and 29% received completely HLA-A,B-mismatched transplants (p less than 0.01). More than 30% received transplants mismatched at 2 HLA-DR antigens (p less than 0.01) (UCLA Registry). 9. Although there were clear racial differences in the original diseases leading to end-stage renal disease, the recipient's race was a stronger predictor of graft outcome than disease (UCLA Registry).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Recent improvements in cadaver-donor kidney retransplantation.

1. Since 1988, 1-year graft survival rates of first cadaver transplants have improved from 78 to 80% (p less than 0.01) in both the UCLA and UNOS Renal Transplant Registries. During the same period, regraft survival has improved from 66 to 75% (p less than 0.0001) in the UNOS data and from 67 to 70% in the UCLA Registry. 2. The UCLA Registry data show a decrease in the proportion of high-risk patients [based upon previous graft survival time (PGST) less than 6 months] retransplanted each year from nearly 50% in 1986 to 35% in 1990. This decrease in a dominant risk population may contribute to rapidly improving retransplant survival. 3. Retransplanted patients with a PGST less than 6 months had a 1-year regraft survival rate of 62% versus 74% for those with a PGST longer than 6 months. 4. Sensitization, a positive crossmatch by flow cytometry, HLA-DR mismatches, and Black race were significant high-risk factors in retransplant recipients with a short PGST. For long PGST patients who rejected their previous graft more than 6 months postoperatively, these factors were far less detrimental or had no influence on the outcome. 5. The flow cytometry crossmatch improved 1-year regraft survival from 34% in 30 positive cases to 65% in 28 negative cases for the short PGST patients. More sensitive crossmatch methods may also have contributed to improving regraft survival rates. 6. The 1-year regraft survival in HLA-DR matched short PGST patients was 64% versus 52% with 2 antigens mismatched (p less than 0.01). A yearly analysis of HLA-DR mismatching showed that the number of patients with 2-DR mismatches increased whereas those with no mismatches decreased. The importance of HLA-DR mismatches should be underscored for short PGST patients. 7. Blacks with a long PGST had the same high regraft survival as Whites through the first 3 years. Blacks with a short PGST had an 8% lower 1-year regraft survival rate than Whites (p less than 0.0001). 8. Although patient selection and screening tests for preformed antibody may have contributed to rising regraft survival, the concomitant rise in first transplant survival suggests that improvements in immunosuppression strategies and patient management are also beginning to affect outcomes in the multicenter data.

Adolescent↗
PubMed1991

Sensitization in renal transplantation.

1. The 1-year graft survival rate for 2,615 broadly sensitized patients of first cadaver-donor transplants between 1985 and 1990 was 72%, 7% lower than 15,615 nonsensitized patients and 6% lower than 4,824 moderately sensitized patients. For retransplants, 1,752 broadly sensitized patients had 61% 1-year graft survival rates, 12% lower than 1,299 nonsensitized patients and 8% lower than 1,104 moderately sensitized patients. 2. Rejection of a previous transplant, pretransplant blood transfusions, sex, and a history of pregnancies were the dominant causes of sensitization. 3. The percentage of nontransfused recipients of first cadaver transplants has increased yearly from 10% in 1985 to more than 40% in 1990 in both the UCLA and UNOS Registries. Over the same period, the percentage of broadly sensitized recipients has declined from 15% to 8%. 4. The beneficial effect of pretransplant transfusions (a 4% improvement at 1 year) was limited in first transplants to males and nonsensitized females. No difference in survival rates of sensitized patients comparing transfused and nontransfused was observed. Patients retransplanted without ever being transfused had very poor outcomes. 5. Delayed graft function (DGF) occurred in approximately 20% of nonsensitized, 28% of moderately (1-50% peak PRA), and 37% of broadly sensitized first transplant recipients. Among retransplanted patients, 28% of nonsensitized, 37% of moderately, and 48% of broadly sensitized patients had DGF. 6. HLA-A,B, and DR matching overcame the deleterious effect of sensitization on graft survival. Sensitization had no effect on the outcome of transplants from HLA-identical siblings, but survival decreased by 7-10% in sensitized recipients of mismatched transplants from relatives. Sensitized first cadaver transplant recipients matched for HLA-A,B, or HLA-DR antigens had 1-year survival rates comparable to those of mismatched nonsensitized recipients. 7. First transplant recipients who were nonsensitized using their current serum but had been broadly sensitized in an historical sample had 73% 1-year graft survival, the same as that of patients who were broadly sensitized in their current serum and 6% less than patients who were never sensitized (p less than 0.001). 8. Assuming a random distribution of sensitized patients at UNOS transplant centers using different methods to measure preformed antibody, the antihuman globulin (AHG) method was more sensitive than the NIH or 1-Wash tests. With AHG, 31% of first and 58% of retransplanted patients were broadly sensitized, whereas with the NIH and 1-Wash methods, the corresponding figures were 18-21% and 41-44%.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Transfusion↗
PubMed1991

UCLA and UNOS Registries. Overview.

The subjects of this study were transplant recipients entered in the UCLA Registry file since 1984 and in the UNOS Registry since 1987. [table: see text] 5. Based on the data above, we conclude that the near 20% loss rate in the first year can be roughly allocated as follows: death 3%, technical 3%, agonal kidney damage 6%, and histocompatibility differences 7%. 6. The quality of HLA typing was assessed by examining the frequencies of the various specificities reported for cadaver donors in 8 yearly periods from 1984 to 1991. The A and B loci specificities were remarkably constant. The DR specificities were still undergoing stabilization. 7. No urine output on the first day, which occurred in approximately 10% of the first cadaver-donor transplants, resulted in about a 20 percentage point lower graft survival rate at 1 year. 8. Anuria on the first day increased with cold ischemia time, donor age, cerebral vascular accident donors, and retransplant recipients. 9. Graft survival with anuria on the first day and: [table: see text] 10. When dialysis was required during the first week, there was an approximate 15 percentage point decrease in 1-year graft survival in 25% of the patients. 11. One rejection in the first hospitalization period resulted in 67% 1-year graft survival. More than 1 rejection led to 57% 1-year graft survival. 12. Serum creatinine at discharge was an accurate indicator of subsequent graft survival. Approximately a 7 percentage point drop in 1-year graft survival was noted with each unit of serum creatinine above 2.0 mg/dl.

Adolescent↗