Abstract In the past decade, great progress has been achieved in improving patient outcome following kidney transplantation. Patient mortality and morbidity have been greatly reduced with more specific and more limited immunosuppression regimens for the treatment of acute rejection.1 Excellent graft survival has also been predicted and obtained for patients who received kidneys from related HLA identical or 1-haplotype—-matched donors with low reactivity in the mixed lymphocyte cultures (MLCs).2 The majority of renal transplants, however, have used cadaver donor kidneys either because of the lack of available related donors or nonutilization of related donors because of high MLC reactivity between donor and recipient. Since graft survival rates in the patients with high MLCs are similar to those obtained with cadaveric transplantation,2,3 several newer techniques and approaches have been introduced to improve graft survival in these groups. Better donor-recipient matching through HLA DR typing and more specific immunosuppression with References 1. Vincenti F, Amend W, Feduska NJ, et al: Improved outcome following renal transplantation with reduction in the immunosuppression therapy for rejection episodes. Am J Med 1980;89:107-112.Crossref 2. Cochrum KC, Salvatierra O, Belzer FO: Correlation between MLC stimulation and graft survival in living related and cadaver transplants. Ann Surg 1974;180:617-622.Crossref 3. Cerilli J, Williams MA, Newhouse YG, et al: Correlation of tissue typing, mixed lymphocyte culture, and related donor renal allograft survival. Transplantation 1978;26:218-220.Crossref 4. Opelz G, Sengar DPS, Mickey MR, et al: Effect of blood transfusions on subsequent kidney transplants. Transplant Proc 1973;5:253-259. 5. Vincenti F, Duca RM, Amend W, et al: Immunologic factors determining survival of cadaver-kidney transplants. N Engl J Med 1978;299:793-798.Crossref 6. Briggs JD, Canavan JS, Dick HM, et al: Influence of HLA matching and blood transfusions on renal allograft survival. Transplantation 1978;25:80-85.Crossref 7. Werner-Favre C, Jeannet M, Harder F, et al: Blood transfusions, cytotoxic antibodies, and kidney graft survival. Transplantation 1979; 28:343-346.Crossref 8. Opelz G, Graver B, Terasaki PI: Induction of high kidney graft survival rate by multiple transfusion. Lancet 1981;1:1223-1225.Crossref 9. Persijn GG, Cohen B, Lansbergen Q, et al: Retrospective and prospective studies on the effect of blood transfusions in renal transplantation in the Netherlands. Transplantation 1979;28:396-401.Crossref 10. Opelz G, Terasaki PI: Improvement of kidney-graft survival with increased numbers of blood transfusions. N Engl J Med 1978;299:799-803.Crossref 11. Vincenti F: Blood transfusions guidelines to optimize graft survival in cadaver and related kidney transplantation, abstracted , in Eighth International Congress of Nephrology, June 7-12, 1981 . Athens, University Studio Publishing Co, 1981. 12. Stiller CR, Lockwood BL, Sinclair NR, et al: Beneficial effect of operation-day blood-transfusions on human renal-allograft survival. Lancet 1978;1:169-192.Crossref 13. Williams KA, Ting A, French ME, et al: Peroperative blood-transfusions improve cadaveric renal-allograft survival in nontransfused recipients. Lancet 1980;1:1104-1106.Crossref 14. Hourmant M, Soulillou JP, Bui-Quang D: Beneficial effect of blood transfusions. Transplantation 1979;28:40-43.Crossref 15. Opelz G, Mickey MR, Terasaki PI: Blood transfusions and kidney transplants: Remaining controversies. Transplant Proc 1981;13:136-141. 16. Brynger H, Frisk B, Ahlmen J, et al: Graft survival and blood transfusion , in Robinson BHB (ed): Proceedings of the 14th Congress of the European Dialysis and Transplant Association . Kent, England, Pitman Medical Publishing Co Ltd, 1977, vol 14, pp 290-295. 17. Salvatierra O, Vincenti F, Amend W, et al: Deliberate donor-specific blood transfusions prior to living related renal transplantation. Ann Surg 1980;192:543-552.Crossref 18. Fabre JW, Morris PJ: The effect of donor strain blood pretreatment on renal allograft rejection in rats. Transplantation 1972;14:608-617.Crossref 19. Halasz NA, Orloff MJ, Hirose F: Increased survival of renal homografts in dogs after injection of graft donor blood. Transplantation 1964;2:453-458.Crossref 20. Newton WT, Anderson CB: Planned preimmunization of renal allograft recipients. Surgery 1973;74:430-436. 21. Salvatierra O, Iwaki Y, Vincenti F, et al: Incidence, characteristics and outcome of recipients sensitized after donor-specific blood transfusions. Transplantation , to be published.
Archives of Internal Medicine – American Medical Association
Published: Apr 1, 1982