Biomaterial Database

Recent improvements in cadaver-donor kidney retransplantation. 1991

Y Mitsuishi, and J M Cecka

1. Since 1988, 1-year graft survival rates of first cadaver transplants have improved from 78 to 80% (p less than 0.01) in both the UCLA and UNOS Renal Transplant Registries. During the same period, regraft survival has improved from 66 to 75% (p less than 0.0001) in the UNOS data and from 67 to 70% in the UCLA Registry. 2. The UCLA Registry data show a decrease in the proportion of high-risk patients [based upon previous graft survival time (PGST) less than 6 months] retransplanted each year from nearly 50% in 1986 to 35% in 1990. This decrease in a dominant risk population may contribute to rapidly improving retransplant survival. 3. Retransplanted patients with a PGST less than 6 months had a 1-year regraft survival rate of 62% versus 74% for those with a PGST longer than 6 months. 4. Sensitization, a positive crossmatch by flow cytometry, HLA-DR mismatches, and Black race were significant high-risk factors in retransplant recipients with a short PGST. For long PGST patients who rejected their previous graft more than 6 months postoperatively, these factors were far less detrimental or had no influence on the outcome. 5. The flow cytometry crossmatch improved 1-year regraft survival from 34% in 30 positive cases to 65% in 28 negative cases for the short PGST patients. More sensitive crossmatch methods may also have contributed to improving regraft survival rates. 6. The 1-year regraft survival in HLA-DR matched short PGST patients was 64% versus 52% with 2 antigens mismatched (p less than 0.01). A yearly analysis of HLA-DR mismatching showed that the number of patients with 2-DR mismatches increased whereas those with no mismatches decreased. The importance of HLA-DR mismatches should be underscored for short PGST patients. 7. Blacks with a long PGST had the same high regraft survival as Whites through the first 3 years. Blacks with a short PGST had an 8% lower 1-year regraft survival rate than Whites (p less than 0.0001). 8. Although patient selection and screening tests for preformed antibody may have contributed to rising regraft survival, the concomitant rise in first transplant survival suggests that improvements in immunosuppression strategies and patient management are also beginning to affect outcomes in the multicenter data.

UI	MeSH Term	Description	Entries
D007165	Immunosuppression Therapy	Deliberate prevention or diminution of the host's immune response. It may be nonspecific as in the administration of immunosuppressive agents (drugs or radiation) or by lymphocyte depletion or may be specific as in desensitization or the simultaneous administration of antigen and immunosuppressive drugs.	Antirejection Therapy,Immunosuppression,Immunosuppressive Therapy,Anti-Rejection Therapy,Therapy, Anti-Rejection,Therapy, Antirejection,Anti Rejection Therapy,Anti-Rejection Therapies,Antirejection Therapies,Immunosuppression Therapies,Immunosuppressions,Immunosuppressive Therapies,Therapies, Immunosuppression,Therapies, Immunosuppressive,Therapy, Immunosuppression,Therapy, Immunosuppressive
D007676	Kidney Failure, Chronic	The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.	ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D011183	Postoperative Complications	Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.	Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D012042	Registries	The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.	Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D002102	Cadaver	A dead body, usually a human body.	Corpse,Cadavers,Corpses
D002140	California	State bounded on the east by Nevada and Arizona, on the south by Mexico and the Pacific Ocean on the south and west, and on the north by Oregon.
D005260	Female		Females
D005500	Follow-Up Studies	Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.	Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup