IMPORTANCE OF MINIMIZING HLA-DR MISMATCH AND COLD PRESERVATION TIME IN CADAVERIC RENAL-TRANSPLANTATION

Univariate and multivariate analyses have been performed on donor and recipient variables to determine possible effects on the outcome of 51 6 primary cadaveric renal transplants performed in our single center f rom 1989 until 1993. The overall actuarial patient survival at 1 year and 5 years was 94.4% and 87.4%, respectively; the 1 year and 5 year g raft survival rates were 88.3% and 77.8%, respectively. A total of 95 grafts were lost; death with function (35%) and chronic rejection (22% ) were the major causes, Three variables (HLA-DR mismatch, delayed gra ft function, and prolonged cold ischemia time) had a significant detri mental effect on both short- and long-term graft survival, Zero HLA-DR mismatched grafts showed significantly enhanced survival over those w ith 1 HLA-DR mismatch both at 1 year (92.8% vs, 84.5%) and at 5 years (88.3% vs, 73.9%) only if cold ischemia time was less than 26 hours (P =0.0009), Occurrence of delayed graft function significantly lowered g raft survival at both 1 year and 5 years (P=0.002), and the incidence was significantly associated with prolonged cold ischemia time (P<0.00 01). HLA-A or HLA-B matching, percentage panel reactive antibodies (PR A), and anastomosis time showed no independent effect on long-term sur vival, The small number of 2 HLA-DR mismatched grafts (n=6) precluded separate analysis of this group, Acute rejection accounted for 12% of losses but had no statistically significant effect on graft survival, even though an increased frequency of rejection episodes was significa ntly associated with HLA-DR mismatch (P<0.0001). These results would s uggest that significant survival benefits may be achieved by prospecti ve HLA matching if cold ischemia times are limited, The efficiency of organ sharing must be improved to make optimal use of a limited resour ce.