Why Do Secondary Cadaver Renal Transplants Succeed? Results of the South-eastern Organ Procurement Foundation Prospective Study, 1977-1982

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Abstract
The selective and therapeutic factors affecting multiple kidney transplant success from a prospective multicenter study of the South-Eastern Organ Procurement Foundation [USA] were reported [in humans]. From June 1977 to March 1982, 3215 cadaver kidney transplants were performed at 39 institutions. There were 2535 first, 564 second, 103 third and 13 fourth grafts. The actuarial graft survival rates 1 and 2 yr were 52 .+-. 1 and 45 .+-. 1%, respectively, for 1st grafts, 44 .+-. 2 and 40 .+-. 3% for 2nd grafts, and 42 .+-. 5 and 31 .+-. 6% for 3rd grafts. Graft survival rates were significantly lower for 2nd and 3rd than for 1st transplants (P < 0.003). There was no difference in patient survival rates. The data were analyzed to determine which selective and therapeutic variables governed success of primary and secondary grafts. Pretransplant blood transfusions were associated with a significant increase in graft survival rates in primary (P < 0.0005) and secondary transplants (P < 0.01), and did not affect patient survival rates. The administration of antilymphocyte serum also improved graft survival rates significantly in primary (P < 0.00005) and secondary grafts (P < 0.00002), wihtout alteration of patient survival rates. HLA compatibility improved primary graft survival rates (P .ltoreq. 0.22), but this did not reach statistical significance in secondary graft survival rates. Second transplant graft survival rates were best when the primary graft functioned for > 12 mo. (Breslow P < 0.02), but were not related to the reason for loss of the 1st graft. Pretransplant bilateral nephrectomy improved graft survival rates significantly, but this phenomenon was linked to other treatment factors. No beneficial effect on graft survival rate could be shown after pretransplant splenectomy in patients with primary or secondary grafts, and this procedure was associated with reduced patient survival rates in both groups.