Renal regrafts

Abstract

1. Approximately 15% of kidney transplants each year were regrafts. 2. One-year survival of cadaveric second transplants was 66.1% vs 75.9% for first transplants. One-year survival of second transplants from living donors was 82.7% vs 89.4% for first transplants. 3. The major difference between first and second transplants was from graft loss within the first month (14.1% for second transplants vs 6.5% for first transplants). 4. Patients younger than age 10 and older than 60 were poor candidates for regrafts. One-year graft survival was 46.1% and 51.7%, respectively. Patients 31-40 years old had a 1-year graft survival rate of 68.9%. 5. HLA-matched regrafts functioned better than mismatched grafts. A 4-antigen HLA-B,DR mismatch was associated with a decreased 3-month graft survival of 11.6% (p = 0.001 vs 0 mismatches). PRA levels or flow cytometry crossmatches may be better predictors of second graft outcome. Patients with PRA levels of 10-100% prior to retransplantation had a 6-7% lower 1-year graft survival than patients who never developed antibodies. 6. Patients with end-stage renal disease from diabetes had similar graft survival rates to patients with other diseases. Diabetes, however, was associated with a 2.9% higher death rate at 1 year (p = 0.03). 7. Parous females responded similarly to nulliparous female or male recipients. 8. Female donor regrafts were associated with an 8% lower 1-year graft survival rate when compared to kidneys from male donors. 9. Black donor regrafts to nonblack recipients were associated with a 13.8% lower 1-year graft survival. Black recipients had a 7% lower 1-year graft survival rate compared to nonblack recipients. 10. Regrafted patients benefited from preoperative transfusions only if they had never received blood products previously. 11. First graft survival less than 6 months was associated with a 5-15% lower second graft survival rate at 1 year. Thereafter, the graft failure rate was higher in patients whose first graft survived more than 6 months. By 6 or 7 years responders and nonresponders had equivalent graft survival. 12. Long-term graft survival may be adversely affected by CsA. 13. The optimum interval between first graft failure and regrafting was 1-6 months.