Figure 6.11 shows the results of living donor graft survival rates by donor relationship in a cohort of transplant recipients from 1988-2000. Results are expressed in terms of half-life survival. In fact, for kidney transplants reported to the UNOS Scientific Registry during a more recent era (1996-2000), the HLA mismatched living donor grafts had superior outcomes versus the 0-antigen mismatched cadaveric grafts (Fig. 6.12). This indicates that the health of kidney donor and recipient, the elective timing of the transplant, the short cold ischemia time, the immediate function of the graft, and other factors are very important determinants of outcome over and above HLA matching by itself. Within the cadaveric transplant group, collections of large numbers of cases show subtle differences in graft survival rates according to the degree of mismatching. Only kidneys from 0 HLA antigen mismatched cadaveric donors seem to confer a survival advantage over the longer-term (Table 6.12).

Effect of PRA level. It has been recognized that highly sensitized patients have relatively poorer outcome because of greater likelihood of graft loss from immu-nological causes. Table 6.13 shows outcomes in recipients stratified according to pre-transplant PRA level. The higher the PRA level the worse the outcome.

Effect of race. Recipient race has an impact on renal transplant outcome in both cadaver and living donor transplants. In general, the rate of graft loss in African Americian recipients, especially after the first year posttransplant, is nearly double compared to Caucasians and other ethnic groups (Fig. 6.13).

Fig. 6.12. Kidney allograft functional survival according to the donor relationship and HLA compatibility. (Reprinted with permission from: Clinical Transplants 2001, editor Cecka and Terasaki, Publisher UCLA Tissue Typing Laboratory, 2002).

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