The benefit and underutilization of sharing kidneys for better histocompatibility.
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.
Takiff
H
H
Department of Surgery, UCLA School of Medicine 90024.
Iwaki
Y
Y
Cecka
M
M
Terasaki
P I
PI
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