ABSTRACT
The impact of potential risk factors for development of panel reactive antibodies (PRA) in 1078 cadaveric kidney graft recipients was investigated in a multivariate analysis. Multiple transplantation, transfusion of more than five blood units and more than two pregnancies were revealed as factors with a significant independent impact on the formation of high levels of PRA. Multiple transplantation and polytransfusion also affected primary non-function, initial function and long-term graft survival at 1, 3 and 5 years. Incidence of early rejection (within 30 days) was significantly increased with repeated transplantation and decreased with a full-house HLA match. However, these effects on transplantation outcome could only be observed when risk factors lead to the formation of antibodies. In patients with risk factors present, but without subsequent sensitization, the graft survival expectation was the same as in patients in whom risk factors were absent.
Subject(s)
Antibodies/blood , Graft Survival/immunology , Kidney Transplantation/immunology , Blood Transfusion , Female , Follow-Up Studies , Histocompatibility Testing , Humans , Kidney Transplantation/pathology , Kidney Transplantation/physiology , Pregnancy , Pregnancy Complications/immunology , Reoperation/statistics & numerical data , Risk Factors , Time Factors , Treatment Failure , Treatment OutcomeABSTRACT
The purpose of this study was to investigate the impact of prenephrectomy donor tissue typing on tissue typing quality and transplantation outcome in human kidney transplantation. We report on 680 consecutive kidney transplantations performed at the Vienna Transplantation Center from 1986 to June 1991. In 343 of them, HLA typing was performed using donor lymph node cells obtained in a small surgical procedure several hours before organ retrieval. The mean cold ischemia time (CIT) could be reduced to 17.7 h in these patients compared with 21.9 h in the control group (n = 337, conventional tissue typing using spleen lymphocytes obtained during the organ removal, P = 0.0001). There was a trend towards better initial and long-term function in the lymph node group; however, this did not reach statistical significance. The clarity of tissue typing results was significantly better when lymph nodes were used as the lymphocyte source. We conclude that prenephrectomy tissue typing is a feasable and inexpensive method of shortening CIT in renal transplantation and favors HLA typing, both likely to benefit transplantation outcome particularly within organ exchange programs.
