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PubMed1992

[Kidney retransplantation: results and prognostic factors].

48 non primary renal transplants were performed in 40 recipients during the 1973-1990 period in our institution (40 second grafts, 6 third grafts and 1 four and fifth grafts). Despite poor HLA matching our second graft survival rates compare favorably with others (80% and 70%, 1 and 5 year graft survival rates). The type of immunosuppression (including ciclosporine A or not) and the duration of the first graft had an influence on the outcome of second grafts. Our experience with repeated retransplantation is limited, but graft survival appears to be poor: most of the grafts were rejected within 2 years (or less). However patient survival was not affected by overimmunosuppression following multiple grafts.

Adolescent↗
PubMed1991

Assessment of interaction among risk factors in three-month graft survival of first cadaveric renal transplantations: a case-control study.

1. Most multivariate analyses of first cadaver-donor kidney grafts have assumed additivity of covariate effects, ignoring possible interaction terms. Using 21,895 primary cadaveric renal transplants reported to the UNOS Kidney Registry, we attempted to assess whether or not strong interaction effects on graft survival existed among 11 important factors. Due to the small number of cases for many multiway factor combinations, our interaction analyses were limited to studying how stratification by 1 factor affected the graft failure risks of a second factor. Two stratification factors were chosen: recipient race and age. 2. Although there was little evidence of strong factor interaction across 5 racial groupings, differences in risk for several factors (recipient age, donor race, donor age, HLA-B,DR mismatching, and cold ischemia time) between Blacks and non-Blacks appeared to be nonadditive (2 examples listed in Table 3). 3. In a more restricted population of White recipients older than age 16, there was only evidence of interacting effects on 3-month graft survival between donor sex and recipient age. 4. Despite many pairwise factor associations (Figs. 1, 3), it appears that the majority of the transplant covariates are additive with respect to the risk of early graft loss. In future analyses, we suggest inclusion of appropriate interaction terms relating the above-mentioned factors with recipient race and age.

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↗
PubMed1986

[Growth of transplanted kidneys].

Two or more years after a kidney transplantation were determined the GFR as 51Cr-EDTA-clearance and the effective renal plasma flow as 125J-hippuran clearance. In 14 children the results of the clearance with the HLA-identity (HLA-I), the quantity of the transfusion units (TU) received before the transplantation and the duration of the cold ischaemia time (CIT) were correlated. While with HLA-I and TU no connections could be proved, the results of the clearance seemed to be reversedly proportional to the CIT (r = -0.53 and -0.64 for GFR and ERPF) for a longer time after transplantation. Different age between donor and recipient shows worse results of clearance in the group of the adults who received a kidney of a child, in contrast to the other three possible combinations of the kidney transplantation.

Adult↗