Cadaveric Kidney Allograft Research Articles

Baseline biopsy for the quality assessment of kidney graft

In addition to the usual clinical and biological criteria for quality assessment of cadaveric kidney allografts, baseline biopsy might take a compelling place in donor selection and the prediction of recipient outcome. This review on kidney graft assessment focuses on the usefulness of baseline biopsy as it may impact on the following: donor status concerning cold ischemic and reperfusion injuries, incidentally found donor nephropathy with unknown consequence on kidney graft outcome, acute and chronic donor changes that might interfere with early and late kidney graft survival, and chronic donor changes that take part of chronic allograft lesions and may influence analysis of subsequent biopsies. Finally, judicious allocation of kidney grafts from marginal donors requires discriminating histologic tools.

Vitamin K deficiency with hemorrhage after kidney and combined kidney–pancreas transplantation

Vitamin K deficiency is a common occurrence in the surgical and intensive care unit population, but its incidence in kidney and combined kidney-pancreas allograft recipients has not been described. We report four patients who received cadaveric kidney or combined kidney-pancreas allografts and subsequently developed significant bleeding associated with deficiency of vitamin K. Their coagulopathy promptly resolved with the parenteral administration of vitamin K. Treatment with vitamin K should be considered in kidney or combined kidney-pancreas allograft recipients with a prolonged prothrombin or partial thromboplastin time during the first postoperative week to avoid hemorrhagic complications.

Histopathological findings in renal allografts at time of transplantation and correlation with onset of graft function.

Histopathological changes quantified using the chronic allograft damage index (CADI) have been shown to predict subsequent graft outcome and developing chronic rejection. The aim of the study reported here was to investigate the extent to which cadaveric renal allografts exhibit histopathological changes at time of transplantation, focusing on changes covered by the CADI. We also analysed whether any histopathological change predicts delayed graft function. One hundred and twenty-eight cadaveric kidney allografts with adequate protocol biopsy were studied. Tubular epithelial anisometric vacuolization was the commonest change, found in 62% of grafts and scored moderate or severe in 28% of these cases. Other prevalent changes were interstitial fibrosis, vascular hyalinosis, glomerular sclerosis and tubular basement-membrane thickening in 40%, 37%, 28% and 22% of biopsies, respectively. Intensities were, however, scored as mild in over 95% of specimens. The mean CADI for all grafts was 0.74. A significant difference in CADIs was seen between grafts from donors under and over 40 years of age. Grafts with early, delayed and no function had a similar incidence of histopathological changes. Histopathological changes in renal allografts were mostly uncommon and mild at time of transplantation, but some grafts exhibited changes which were quantified using the CADI. Though histopathological changes quantified with the CADI are predictive of subsequent graft function, they did not affect onset of graft function.

BASILIXIMAB (SIMULECT???) REDUCES ACUTE REJECTIONS, CMV-INFECTIONS AND DURATION OF HOSPITAL STAY IN RENAL ALLOGRAFT PATIENTS

709 Purpose: Basiliximab (Simulect™, SDZ CHI 621) is a chimeric mAb against the α-chain of the IL-2 receptor (CD25). Its efficacy and safety in renal transplantation was determined in a multicenter, randomised, double-blind, placebo controlled phase-III trial. Here we present the data of 41 consecutive patients treated at our institution. Methods: Fourty-one recipients of primary mismatched cadaveric kidney allografts were enrolled in this study between 4/95 and 1/96. Twenty-one patients received two 20-mg doses of basiliximab and twenty patients received placebo on day 0 and 4, respectively. Baseline immunosuppression consisted of the new CyA-microemulsion (Neoral™), target levels: 150-200 ng/ml, and low dose corticosteroids. Primary objective was the incidence of acute rejections during the first six month. Secondary objectives were the safety and tolerability of basiliximab, as well as patient and graft survival up to 12 month post-transplantation. Results: [1] No significant differences regarding sex, height, weight, cold ischemic time, initial non function, time on dialysis, or history of end-stage renal disease could be observed between both treatment groups. [2] Biopsy proven acute rejections were significantly reduced in the basiliximab treated group compared with the placebo group: 28,6 % versus 55%,(p<0.05). [3] No steroid resistant acute rejections were seen in the basiliximab group vs. five (25%) in the placebo group (p=0.02). [4] One CMV-infection (4%) was observed in the basiliximab treated group, compared with five CMV-infections (25%) in the placebo group (p=0.02). [5] The incidence of bacterial infections (mainly UTI) was slightly decreased in the basiliximab group. [6] Patient survival at 24 month was 100 % in both groups.[7] Two patients lost their graft in the basiliximab group (venous thrombosis of the graft) and one patient in the placebo group (anaemic infarction of the kidney). [8] No post-transplant lymphoproliferative disorders occurred up to 24 month. [9] Acute tolerability was excellent, with no signs of cytokine release syndrome. [10] The initial hospital stay was longer in the placebo group (35 days; range: 7-73) compared with the basiliximab group (25 days; range: 4-58). Conclusion: Basiliximab was well tolerated in kidney transplanted recipients. Prophylactic treatment with 40-mg of basiliximab significantly reduces the incidence and severity of acute rejections, the incidence of CMV-infections and the duration of hospital stay in renal allograft patients.

The effect of antilymphocyte induction therapy on renal allograft survival. A meta-analysis of individual patient-level data. Anti-Lymphocyte Antibody Induction Therapy Study Group.

Randomized, controlled trials have not shown that the perioperative use of antilymphocyte antibodies (induction therapy) improves survival of cadaveric kidney allografts. This study combined individual patient-level data from published trials to examine the effect of induction therapy on allograft survival. Randomized, controlled trials identified from MEDLINE. Published trials that compared adult recipients of cadaveric renal allografts who did and did not receive antilymphocyte antibodies in the perioperative period were selected if individual patient-level data were available. Individual patient-level data were collected for each of 628 study patients. Multivariable Cox proportional hazards regression was used to estimate the effect of induction therapy on allograft survival. The adjusted rate ratio for allograft failure with induction therapy compared with conventional therapy was 0.62 (95% CI, 0.43 to 0.90) (P = 0.012) over 2 years and 0.82 (CI, 0.62 to 1.09) (P = 0.17) over 5 years. The effect of induction therapy on allograft survival diminished over time; no benefit overall was seen after 2 years after transplantation (rate ratio, 1.13 [CI, 0.72 to 1.78]) (P > 0.2). Greater HLA-DR mismatch, delayed allograft function, diabetes mellitus in the recipient, African-American ethnicity of the recipient, and presensitization (panel-reactive antibody levels > or = 20%) were significantly associated with allograft failure at 5 years. Among high-risk patients, only those who were presensitized benefited from induction therapy at 2 years (rate ratio, 0.12 [CI, 0.03 to 0.44]) (P = 0.001). Results were similar at 5 years. Using individual-level data, this study showed a benefit of induction therapy at 2 years, particularly among presensitized patients. Although the benefit of this therapy subsequently waned, presensitized patients continued to have benefit at 5 years.

Effect of anti-lymphocyte induction therapy on renal allograft survival: a meta-analysis.

Induction immunosuppression with antilymphocyte antibodies has not been shown to improve cadaveric kidney allograft survival in randomized, controlled trials despite widespread use. This meta-analysis of randomized, controlled trials assessed the effectiveness of induction therapy in prolonging allograft survival. Studies of induction therapy were identified in Medline (1986 through 1996), using the terms "monoclonal antibodies" or "antilymphocyte serum," and "kidney transplantation," "human," and "clinical trial." Bibliographies, pharmaceutical manufacturers, the United Network for Organ Sharing, National Institutes of Health, and study authors were also consulted. Seven of 247 identified studies met the following inclusion criteria: (1) an adult study population; (2) assessment of antilymphocyte antibodies in the immediate posttransplant period; (3) a control arm of cyclosporine, azathioprine, and prednisone in the immediate posttransplant period; and (4) presentation of survival data. Two readers independently extracted protocol and survival data from each study. Summary odds ratios (fixed and random effects) and a rate ratio from proportional hazards regression at 2 yr were estimated to examine the effect of induction therapy on allograft survival. The summary odds ratios were both 0.66 (confidence interval [CI], 0.45 to 0.96; P = 0.03), and the rate ratio was 0.69 (CI, 0.49 to 0.97; P = 0.03), indicating a beneficial effect of induction therapy on allograft survival. Allograft survival was 85.6% (CI, 82.1 to 89.1%) in the induction therapy group and 79.6% (CI, 75.6 to 83.6%) in the conventional therapy group. These results were stable in a sensitivity analysis based on study quality. Allograft survival was prolonged with induction therapy compared with conventional immunosuppression. These data indicate a potential role for the routine use of induction therapy in renal transplantation to optimize the survival of cadaveric allografts.

National kidney allograft sharing: a decision analysis.

Expansion of the current program of national sharing of cadaveric kidney allografts is of uncertain benefit, and the logistical barriers to expanding organ sharing are large. This study estimated the improvement in allograft survival from expanding organ sharing in the United States. A decision analysis based on allograft survival data from cadaveric allograft recipients throughout the United States compared the mean allograft survival resulting from four allograft-sharing strategies: no national sharing, national sharing of allografts matched at 6 histocompatibility alleles, national sharing of allografts matched at 4 or more alleles, and national sharing of allografts matched at 2 or more alleles. Sharing allografts matched at 4 or more alleles was optimal (mean allograft survival=6.35 years). This survival was little better than the mean survival of the other three strategies (no national sharing, 6.21 years; national sharing of allografts matched at 6 alleles, 6.31 years; and sharing of allografts matched at 2 or more alleles, 6.33 years). The increment in the proportion of allografts surviving 4 years or more under the optimal strategy compared with no national sharing was <2%. A similar decision model comparing kidney transplant outcomes before and after the introduction of cyclosporine showed that this drug has had a much greater impact on mean allograft survival than would be expected to occur with national allograft sharing: 6.07 years with cyclosporine versus 3.79 years without cyclosporine. Expanding national allograft sharing would achieve little improvement in mean allograft survival. The limited benefit and logistical barriers to expansion of allograft sharing should be considered before following recommendations to expand the current U.S. allograft-sharing program.

Anti-CD4 MoAb therapy in kidney transplantation--a pilot study in early prophylaxis of rejection.

B-F5, a mouse IgG1 anti-CD4 MoAb, was used in recipients of a first cadaveric kidney allograft. Eighteen patients received 30 mg/day MoAb with a quadruple sequential therapy. All but one kidney were functioning at 6 months, with a mean serum creatinine of 153 micromol/L. However, 50% of the patients had an acute rejection episode within the first three months, and most of the early episodes (i.e., < 1 month) occurred in patients with low levels of circulating MoAb. The biological analysis showed a strong depleting effect on the CD4+ cell counts, a saturation by the MoAb of the remaining circulating CD4+ cells, and no detectable immunization against B-F5. Although the biological parameters indicate an action of B-F5 in vivo, the clinical data associated with poor MoAb bioavailability suggest the need for an improved pharmacokinetic behavior of the MoAb to determine its use for prophylaxis of early rejection.

A critical analysis of soluble interleukin-2 receptor levels in kidney allograft recipients

Abstract Soluble interleukin-2 receptor (sIL-2R) was measured by the Cellfree Kit (T Cell sciences) in 103 pretransplant and 1590 post-transplant samples from 103 patients with cadaveric kidney allo-grafts. The mean values (± SD) detected in pretransplant sera were significantly higher (1932 ± 1389 U/ml) than in 72 healthy adults (267 ± 139 U/ml), but after transplantation they continuously fell towards normal levels within the first 3 postoperative weeks. Recipients with acute rejection episodes showed higher sIL-2R levels (1762 ± 904 U/ml) than those with stable transplants at discharge (937 ± 398 U/ml). Highest values were detected during antirejection therapy with antithymocyte globulin (4996 ± 2166 Uiml) or OK (5905 ± 3910). Increases were also observed during bacterial and viral infections and even, in some cases, without any apparent cause. Because of this lack of specificity, elevated sIL-2R levels should be interpreted cautiously. Nevertheless, sIL-2R level can be useful for monitoring kidney allograft recipients. Increases point to a cellular immune activation process and can predict rejections or infections.

O881 - Microchimerism frequency and kinetics in cadaveric kidney allograft recipients

O881 - Microchimerism frequency and kinetics in cadaveric kidney allograft recipients

A critical analysis of soluble interleukin-2 receptor levels in kidney allograft recipients.

Soluble interleukin-2 receptor (sIL-2R) was measured by the Cellfree Kit (T Cell sciences) in 103 pretransplant and 1590 posttransplant samples from 103 patients with cadaveric kidney allografts. The mean values (+/- SD) detected in pretransplant sera were significantly higher (1932 +/- 1389 U/ml) than in 72 healthy adults (267 +/- 139 U/ml), but after transplantation they continuously fell towards normal levels within the first 3 postoperative weeks. Recipients with acute rejection episodes showed higher sIL-2R levels (1762 +/- 904 U/ml) than those with stable transplants at discharge (937 +/- 398 U/ml). Highest values were detected during antirejection therapy with antithymocyte globulin (4996 +/- 2166 U/ml) or OKT3 (5905 +/- 3910). Increases were also observed during bacterial and viral infections and even, in some cases, without any apparent cause. Because of this lack of specificity, elevated sIL-2R levels should be interpreted cautiously. Nevertheless, sIL-2R level can be useful for monitoring kidney allograft recipients. Increases point to a cellular immune activation process and can predict rejections or infections.

Pulsatile kidney perfusion for evaluation of high‐risk kidney donors safely expands the donor pool

Pulsatile preservation of cadaveric kidney allografts allows effective organ preservation and the opportunity to obtain information about the quality of the organ during storage. The use of information obtained by measuring FLOW (ml/min) and renal resistance (mean perfusion pressure/FLOW(ml/min)) while kidneys are undergoing pulsatile perfusion offers quantitative data to determine suitability of an organ for transplant. This may be more accurate than the combination of demographic variables with past and current medical information that has been traditionally used to evaluate donor suitability. Wc have evaluated 82 kidneys that received a period of pulsatile preservation at our institution. Kidneys were from consecutive donors age ≥42 years and were stratified into three high risk groups: donor age ≥60 (48%), the presence of hypertension (52%), and IMPORT kidney (48%). All IMPORT kidneys were obtained through UNOS after the local center considered them unacceptable for transplant and none were 6‐antigen match organs. Kidneys were discarded if they failed to have a FLOW≥70 ml/min or RR≤0.4. Twelve kidneys (15%) failed to meet these criteria and were discarded. All 12 kidneys were from donors age ≥60 (p = 0.002). The average FLOW and RR of transplanted kidneys svas 103 ml/min and 0.3283 respectively. Six of 69 (8.6%) transplanted organs required dialysis (ATN). No pump parameters predicted the development of ATN although 5 of 6 kidneys were IMPORTs. Recipient outcome data, including 72‐hour urine output and day 10 serum Cr, were affected by organ risk group, but these did not impact on patient care. Overall 2‐year graft survival was 82%. Two year graft survival was 25% worse in IMPORT compared to LOCAL kidneys (p = 0.0105). Multivariate analysis to determine the risk of dialysis and the risk for graft loss identified IMPORT kidney as the single independent variable. Wc conclude that the use of pulsatile perfusion parameters allows safe selection of kidneys from high‐risk CAD donors with a ATN rate substantially below the national average without compromising patient outcome. Wc believe that these data demonstrate that the use of pump perfusion parameters to select organs for transplantation will allow safe utilization of the marginal CAD donor, especially as programs develop “non‐heart beating donor” protocols.

Systemic chimerism in long-term cadaveric kidney allograft recipients

Systemic chimerism in long-term cadaveric kidney allograft recipients

Renal allograft immunosuppression III. Triple therapy versus three different combinations of double drug treatment: two year results in kidney transplant patients

Abstract. A prospective randomized trial was carried out to compare the long-term effects of triple therapy based on low-dose cyclosporin A (CyA), low-dose methylprednisolone (MP) and azathioprine (Aza) with three different double drug immunosuppressive regimens. After initial triple drug immunosuppression for 10 weeks, 128 patients were randomized into four different immunosuppressive groups: one group continued with triple therapy (group A) and the three other groups were treated with different combinations of two drugs: Aza and CyA (group B), Aza and MP (group C) and CyA and MP (group D). This report presents the 2-year results. For groups A, B, C and D, graft survivals were 75%, 78%, 84% and 81%, respectively, and patient survivals were 84%, 84%, 84% and 94%, respectively. After 2 years no patient had returned to dialysis in group C compared with one to three patients in every CyA-using group. However, at the end of the 2nd year, group C included more patients with deteriorating graft function than the other groups. Median serum creatinine was 107, 120,139 and 129 μmol/l for groups A, B, C and D, respectively. For the patients who remained on the original randomized protocol, there were no significant differences in graft function tests between the four groups, the median creatinine being 115,115,118 and 113 μmol/l for groups A, B, C and D, respectively. Thus, no graft deterioration had occurred during the 2 years for these patients following the original protocol. Our results suggest that after initial triple therapy, patients with a first cadaveric kidney allograft can either continue with triple therapy orbe converted toany of the double drug regimens without detriment to graft function, graft survival or patient survival for the next 2 years. This will allow more flexible and individual immunosuppressive treatment.

LONG-TERM RESULTS OF A CONTROLLED PROSPECTIVE STUDY WITH TRANSFUSION OF DONOR-SPECIFIC BONE MARROW IN 57 CADAVERIC RENAL ALLOGRAFT RECIPIENTS

Experimental studies have shown that antilymphocyte globulin combined with transfusion of donor-specific bone marrow cells can induce partial tolerance to allograft tissue. We have adapted these protocols to clinical use and present the results of 57 cadaveric renal allograft recipients who received Minnesota ALG followed by the transfusion of cryopreserved donor-specific bone marrow. A group of 54 patients received the contralateral kidney and similar immunosuppression without the marrow transfusion and serve as controls. Both groups received quadruple immunosuppression with MALG, cyclosporin, azathioprine, and prednisone. In the bone marrow group, after a 10-14 day induction course of ALG, cryopreserved marrow was transfused on the seventh day after the last dose of ALG. The median follow-up in both groups is 16 months, (range 2.5-33 months). Six grafts have been lost in the bone marrow group, (three rejections, 2 deaths [Cr 2.0, 2.3], 1 recurrent disease). In the control group 16 grafts have been lost (13 rejections, 3 deaths [Cr 1.7, 2.5, 3.0]). Five patients in the control group have biopsy-proved chronic rejection compared to one in the bone marrow group. 17 patients in the bone marrow group have been tapered off the prednisone, and three of these patients have had mild late rejection episodes without graft loss. The two groups were compared for differences in the number of rejection episodes, estimated renal plasma flow, glomerular filtration rate, and urine protein. No differences were found. The allograft survival of the bone marrow group was significantly greater (P less than .01) than the control group. The graft survival rates for the bone marrow group at 12 and 18 months were 90% (confidence limits [CL] 85-94) and 85% (CL 78-90), respectively. In the the control group the 12 and 18 month allograft survival rates were 71% (CL 63-78) and 67% (CL 58-74), respectively. The survival in the control group was similar to our overall transplant experience with quadruple therapy. Mixed lymphocyte culture analysis shows a trend to diminished donor-specific responsiveness in the bone marrow group. The use of cryopreserved donor-specific bone marrow is associated with improved allograft survival in cadaveric kidney allograft recipients. However, a more effective induction protocol is needed to reduce the overall number of rejection episodes.

Renal allograft immunosuppression

A prospective randomized study was conducted to evaluate the impact of four different conversion protocols on graft outcome in long-term follow-up. Between January 1986 and May 1987, 128 patients with first cadaveric kidney allografts were randomized at the time of transplantation to four treatment groups of 32 patients each, to be assigned 10 weeks post-transplantation. During the first 10 weeks, all patients received triple therapy with low-dose azathioprine (Aza), cyclosporin (CyA), and methylprednisolone (MP). After 10 weeks, one group continued with triple therapy (group A) while the three other groups received different combinations of two drugs, namely, Aza and CyA (group B), Aza and MP (group C), or CyA and MP (group D). Withdrawal of MP (group B) or especially of CyA (group C) was associated with 4/29 (14%) and 10/28 (36%) acute rejection episodes, respectively, for 60 days after conversion. All rejections were mild and reversible. There were no rejections after Aza withdrawal or in the group that continued on triple therapy during the corresponding time period. The most common reason for dropping out after withdrawal, for those patients who could not continue on the originally randomized medication, was azathioprine intolerance (n = 12). Five patients were switched back to triple therapy after CyA withdrawal due to rejection. Steroid intolerance was rare and CyA in low doses was very well tolerated. At 1 year there were no statistically significant differences in graft survival between groups A, B, C, and D--81%, 88%, 88%, and 88%, respectively--or in patient survival--88%, 88%, 88%, and 97%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal allograft immunosuppression: II. A randomized trial of withdrawal of one drug in triple drug immunosuppression

Abstract. A prospective randomized study was conducted to evaluate the impact of four different conversion protocols on graft outcome in long-term follow-up. Between January 1986 and May 1987, 128 patients with first cadaveric kidney allografts were randomized at the time of transplantation to four treatment groups of 32 patients each, to be assigned 10 weeks post-transplantation. During the first 10 weeks, all patients received triple therapy with low-dose azathioprine (Aza), cyclosporin (CyA), and methylprednisolone (MP). After 10 weeks, one group continued with triple therapy (group A) while the three other groups received different combinations of two drugs, namely, Aza and CyA (group B), Aza and MP (group C), or CyA and MP (group D). Withdrawal of MP (group B) or especially of CyA (group C) was associated with 4/29 (14%) and 10/28 (36%) acute rejection episodes, respectively, for 60 days after conversion. All rejections were mild and reversible. There were no rejections after Aza withdrawal or in the group that continued on triple therapy during the corresponding time period. The most common reason for dropping out after withdrawal, for those patients who could not continue on the originally randomized medication, was azathioprine intolerance (n= 12). Five patients were switched back to triple therapy after CyA withdrawal due to rejection. Steroid intolerance was rare and CyA in low doses was very well tolerated. At 1 year there were no statistically significant differences in graft survival between groups A, B, C, and D-81 %, 88%, 88%, and 88%, respectively-or in patient survival-88%, 88%, 88%, and 97%, respectively. For those patients continuing with the originally randomized treatment protocol, there were no differences in patient or graft survival either, the means being 91% and 89%, respectively. The most common cause of death after withdrawal was cardiovascular in nature, and there were no more fatal infections under triple drug treatment than with double drug regimens. There were no statistically significant differences in mean serum creatinine values at 1 year. The median serum creatinine values for groups A, B, C, and D were 112, 132, 133, and 133 μmol/l, respectively. At 1 year the mean CyA dose in the groups that continued with CyA was 3. 5–4. 2 mg/kg per day and CyA concentrations were equal.

HLA-DRw6 as a risk factor for active cytomegalovirus but not for herpes simplex virus infection after renal allograft transplantation.

To study genetically determined susceptibility to cytomegalovirus and herpes simplex virus infections in patients given renal transplants a prospective study was performed of 68 consecutive patients receiving their first cadaveric kidney allograft. The recipients positive for HLA-DRw6 showed a significantly increased incidence of active cytomegalovirus infection as early as the 10th week after transplantation (p less than 0.05). No relation with other human leucocyte antigens was found, nor did a correlation exist between HLA typing and the incidence of herpes simplex virus infections. Furthermore, recipients positive for HLA-DRw6 with secondary cytomegalovirus infections excreted infectious virus more often (p less than 0.01) and showed more clinical symptoms (p less than 0.01) than a comparable group of recipients negative for HLA-DRw6. These observations may have practical implications for the treatment of patients who have had renal transplant operations.

THROMBOEMBOLIC COMPLICATIONS AND HAEMOSTATIC CHANGES IN CYCLOSPORIN-TREATED CADAVERIC KIDNEY ALLOGRAFT RECIPIENTS

The incidence of thromboembolic complications was compared retrospectively in 90 cadaveric kidney allograft recipients treated with cyclosporin and low-dose steroids and the same number of cadaveric kidney allograft recipients treated with azathioprine, antilymphocyte globulin, and high-dose steroids. In the cyclosporin group, 17 thromboembolic complications occurred in 13 patients: 10 pulmonary emboli, 1 renal vein thrombosis, 3 deep vein thromboses, and 3 haemorrhoidal thromboses. In the azathioprine group, the only thromboembolic complication was 1 episode of superficial thrombophlebitis. Haemostatic tests in cyclosporin-treated and azathioprine-treated patients and normal subjects (10 in each group) showed increased concentrations of factor VIII C, fibrinogen, antithrombin III, and protein C in the cyclosporin-treated patients. Adenosine-5'-diphosphate-induced platelet aggregation was also significantly enhanced in the cyclosporin group. The effect of cyclosporin on haemostasis may predispose to thromboembolic complications.

Importance of HLA-DR matching in polytransfused cadaveric kidney transplant recipients. A prospective one-center study.

Since August 1978 prospective HLA-DR typing has been performed in 157 donor-recipient pairs. All recipients received pretransplant blood transfusions. This study shows that HLA-DR matching can significantly improve the survival of cadaveric kidney allografts, even in polytransfused recipients. Patients receiving kidneys with no HLA-DR incompatibilities have a one-year graft survival of 97%, versus 86% for recipients with 1 HLA-DR incompatibility and 73% for recipients with 2 HLA-DR incompatibilities. The cumulative dose of corticosteroids during the first year after transplantation is significantly lower in patients with no DR-incompatibilities. HLA-A and B matching have no additional effect on graft survival.