title: The benefit and underutilization of sharing kidneys for better histocompatibility.
abstract: The data of the UCLA Kidney Transplant Registry were reviewed with regard to sharing. The percentage of first-cadaver cyclosporine-treated transplants since 1984 with long cold ischemia time increased with sharing distance: 25% of unshared grafts, 40% of locally shared, and 61% of distantly shared ones had cold ischemia times over 24 hr; for cold ischemia times over 36 hr the numbers were 6%, 12%, and 24%, respectively. The immediate function rate did not parallel sharing distance the way cold ischemia time did: 85.7% without sharing, 74.4% with local sharing, and 83.5% with distant sharing. The percentage of well-matched (0 HLA-B,DR mismatches) transplants was low (3-5%) regardless of sharing status. Well-matched shared grafts with cyclosporine immunosuppression had a 9% survival advantage at one year compared with poorly matched unshared ones (85% vs. 76%). Long-term, well-matched shared grafts had a half-life of 11.9 years compared with 7.5 years for poorly matched unshared ones (reflecting graft loss from 3 to 10 years posttransplant). We conclude that sharing for histocompatibility has an overall beneficial effect.
authors.affiliation: Department of Surgery, UCLA School of Medicine 90024.
authors.forename: H
authors.initials: H
authors.lastname: Takiff
authors.forename: Y
authors.initials: Y
authors.lastname: Iwaki
authors.forename: M
authors.initials: M
authors.lastname: Cecka
authors.forename: P I
authors.initials: PI
authors.lastname: Terasaki
mesh_terms: D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007511:Ischemia; D016030:Kidney Transplantation; D009926:Organ Preservation / Q000379:methods; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014186:Transportation