SEQUENTIAL RENAL-TRANSPLANTS - SOME SURGICAL AND IMMUNOLOGICAL IMPLICATIONS ON MANAGEMENT OF 1ST HOMOGRAFT

  • 1 January 1976
    • journal article
    • research article
    • Vol. 79  (3) , 262-267
Abstract
Experience with 35 second grafts included in a total number of 310 renal transplants was analyzed to identify factors associated with success. The 2 yr life-table renal survival rate of sequential cadaveric grafts is 42% compared to 54% for primary cadaveric grafts. The 2 yr life-table patient survival rate for the same group is 68% compared to 72% for single cadaveric homotransplants. Of 30 patients 21 tested in the interval between grafts developed cytotoxic antibodies to greater than 5% of a random panel of cells; 43% of these kidneys functioned at least 1 yr; 65% functioned for 1 yr or more if the cytotoxicity was 5% or less. If the 1st graft functioned greater than 3 mo., the 2nd had a 67% chance of functioning for 1 yr; if less than 3 mo., the 2nd had a 45% 1 yr function rate. Removal of the 1st transplant at time of 2nd transplantation resulted in an 88% 1 yr life-table survival rate of the 2nd kidney in 9 patients. Removal prior to 2nd transplantation resulted in a 25% 1 yr survival rate in 23 patients. To further evaluate this significant finding, data was obtained through the American College of Surgeons/National Institutes of Health Organ Transplant Registry from 5 major transplant centers. Thirty-two patients had their 1st graft removed at time of 2nd transplantation with a 52% 1 yr life-table kidney survival rate vs. 29% if the 1st were removed more than 90 days prior to 2nd grafting. Statistical analysis shows this to be significant at the 95% confidence level.