Factors influencing outcome after deceased heart beating donor kidney transplantation in the United Kingdom: an evidence base for a new national kidney allocation policy.

BACKGROUND: Outcomes after deceased heart beating donor kidney transplantation are good, but survival rates vary according to a number of donor-, recipient-, and transplant-related factors. This comprehensive analysis of transplant outcomes was undertaken to inform development of a new Kidney Allocation Scheme. METHODS: A complete case analysis of the outcome of kidney-only transplants in the United Kingdom, 1995 to 2001, was undertaken using Cox regression modeling. Seven thousand three hundred eighty-five (77%) of the 9585 transplants reported to the UK Transplant Registry were primary transplants in adults. Regrafts and pediatric patients (age <18 years) were analyzed separately. Transplant and patient survival over 5 years were investigated in addition to causes of prolonged cold ischemia time (CIT). RESULTS: A variety of factors significantly adversely influenced kidney transplant and patient outcome, including older donor age, older recipient age, waiting time to transplant over 2 years, diabetes, and earlier year of transplant. Human leukocyte antigen mismatch and CIT were significant in analyses of transplant but not in patient outcome, and an increased graft failure rate was also identified in adolescent patients. CIT was prolonged by long-distance kidney exchanges between centers (2 hr) and reallocation of kidneys for alternative patients (7 hr). CONCLUSION: This study identified a number of factors that influence transplant outcome after deceased heart beating donor kidney transplant in the United Kingdom. The findings suggest that the influences of human leukocyte antigen mismatch and CIT are most relevant in considering a revised kidney allocation scheme.

Renal after cardiothoracic transplant: the effect of repeat mismatches on outcome.

BACKGROUND: Histocompatibility matching is not considered important in nonrenal solid organ transplants (NRSOT). There is no evidence to base guidance on whether mismatched human leukocyte antigen (HLA) antigens should be avoided in subsequent renal transplantation. METHODS: This study examines the effect of repeat HLA mismatches on renal allograft survival and function in all renal after cardiothoracic transplants undertaken in the United Kingdom between 1997 and 2003 using the UK Transplant data. RESULTS: A repeat HLA-A, -B, or -DR mismatch occurred in 16 of 53 (30%) cases. Recipients without a repeat mismatch were more likely to be male, but recipient age, donor age, recipient-donor age difference, donor gender, donor type, or cold ischemia time were comparable. Immunosuppressive therapy was similar in both groups. No differences were observed in renal allograft function at 1 or 5 years between the repeat mismatch group (estimated glomerular filtration rate [mean+/-standard deviation] 41.6+/-16.6 and 37.5+/-12.8 mL/min/1.73 m2) and the no repeat mismatch group (47.2+/-15.7 and 48.0+/-15.9 mL/min/1.73 m2). Renal allograft survival was also similar in the two groups at 1 and 5 years. CONCLUSIONS: In this limited, heterogeneous, observational cohort of cardiothoracic transplant patients who went on to receive a sequential kidney transplant, a repeated HLA antigen mismatch was not associated with a detrimental effect on kidney transplant outcome.