A report on 123 six‐antigen matched cadaver kidney transplants

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Abstract
A national program of shipping six‐antigen matched cadaver kidneys through the UNOS organization has resulted in higher graft survival than many had anticipated. Compared to the control non‐shipped first cadaver donor kidneys which had 1‐year graft survival of 79%, 91 six‐antigen matched cadaver kidneys shipped from 56 centers had 1‐yr graft survival rates of 90% (p<0.01). Among 30 retransplants, the 1‐yr cadaver graft survival was 87%. The 1‐yr cadaver graft survival was even higher (94%) in first grafts in which the recipient's HLA antigens were well defined types. There were 2 deaths in the 123 transplants and 3 patients lost their grafts within 3 days due to thrombosis. Despite transplantation into 17 patients with peak cytotoxic antibody reactive to more than 80% of the panel, no deleterious effect of sensitization was noted. Also, no adverse effect of long cold ischemia time (up to 51 hours) was seen in this series. Acute tubular necrosis had no effect on survivial of first grafts but did have a small, non‐statistically significant effect on second grafts. A 100% survival rate at 6 months was noted among 67 patients whose serum creatinine levels were less than 3.0 mg/dl at time of discharge. Thirteen patients with creatinine values of more than 3 had an 80% survival. The average creatinine values at 3, 6 and 12 months were 1.7 at all intervals. We conclude that six‐antigen matched cadaver transplants can overcome factors such as prior immunization, effect of shipping with cold ischemia under 40 h and the center effect.