Abstract
Until December 31, 1980, 1, 700 renal transplants including 1, 461 living related grafts were performed in Japan. The overall patient and graft survival of the related transplants at 5 years were 67.3% and 46.5%. Since 1971, both patient and graft survival have been improving and recent 3-year patient survival was about 15% higher than that of patients on hemodialysis.
In related transplants, graft survival is strongly influenced with the shared haplotypes by donors and recipients. Namely, while the survival of the grafts from 2-haplotype identical sibling can be expected about 90% at 5 years; that of 1-haplotype identical grafts is about 50%. The survival rate of the latter is not satisfactory for the donation from living relatives.
In 1980, the beneficial effects of HLA-DR matching and pretransplant blood transfusions on cadaver transplants was confirmed in the International Histocompatibility Workshop Study on Renal Transplantation. However, because of small number of related donor transplants, this analysis was limited to grafts from cadaver donors.
Ninety seven living related transplants performed at The Institute of Medical Science Hospital, The University of Tokyo were analyzed on the effects of HLA-D matching, HLA-DR matching and pretransplant blood transfusions. Actuarial survival rate of the HLA-D compatible grafts at 5 years was 85.5% and that of the HLA-D incompatible grafts was 46.5%, resulting in a significant difference (P<0.05).
The correlation between HLA-DR matching and graft survival was examined in donor-recipient combinations excluding 2-haplotype identical siblings. One-year survival of the 2-DR antigen-matched grafts was 81.8%; that of the 1-DR antigen-mismatched grafts was 72.4%. There was no statistical significace.
Among 1-DR antigen-mismatched grafts, 50.0% of the recipients preoperatively transfused with less than 1000ml blood lost their graft function within 1 year. The graft survival rate (50.0%) was significantly lower (P<0.01) than in recipients preopreatively transfused with more than 1200ml blood (93.3%). From these results, it might be possible that pretransplant blood transfusions improve the survival of the 1-DR antigen-mismatched grafts up to the level of that in 2-haplotype identical siblings.
Besides random transfusions, donor-specific blood transfusions in related transplants have been initiated at some centers. Recent reports of Salvatierra and ours indicated that the administration of 200ml of donor blood on 3 separate occasions at 2-week intervals proved to be effective for a purpose of improving the survival of the related kidney grafts without producing cytotoxic antibodies against the donors.
