Deduction of the fraction of immunologic and non-immunologic failure in cadaver donor transplants

Abstract

We utilized the UNOS Registry graft survival records to determine the fraction of graft failures attributable to immunological or non-immunological factors. Ten-year graft survival of HLA-identical sibling donor grafts was 77% excluding deaths, diabetics, Black recipients, recipients older than age 50, and those who required post-transplant dialysis. With similar exclusions, 10 year graft survival from living HLA-mismatched donors was 66%. To account for the overall 60% graft failures at 10 years for all cadaver donors, we deduced that 38% of the failures were due to immunological reactions against non-HLA factors as seen in HLA-identical sibling grafts; 18% of failures were due to HLA factors, as seen in mismatched living donor grafts; and the remainder of 43% was attributable to non-immunological factors.