Sensitization and crossmatching in renal transplantation.

1. Presensitization in first cadaver kidney recipients can lead to increased risk of graft failure by hyperacute rejection, or delayed function up to 1 month. Fifty percent of the hyperacute rejections occurred in nonsensitized recipients. The number of "classical" hyperacute rejections was small, but they have been occurring at a rate of about 10 per year. 2. One-year graft survival of nonsensitized recipients of first and second cadaver transplants was about the same. One-year graft survival of broadly sensitized recipients of first and second cadaver transplants was 8% lower than those who were moderately sensitized. One-year graft survival of second cadaver transplants in all sensitized recipients was significantly lower (9-13%) than in first cadaver transplants. 3. The proportion of transfused recipients was 89% in parous females, 84% in nulliparous females, and 80% in males. Pretransplant transfusions also increased sensitization of males and females awaiting their first kidney transplant. Females were significantly more sensitized than males, whether they were transfused or not. 4. One-year graft survival rates of transfused recipients were 5-9% higher than nontransfused recipients. Highly sensitized patients who were transfused had the same 1-year graft survival as nontransfused, nonsensitized recipients. 5. Patients in Southern California waiting for a second transplant were more broadly sensitized than those waiting for a first kidney. A higher proportion of sensitized patients were waiting more than 3 years for a second transplant than for a first. 6. Patients waiting for a first transplant were more sensitized than those transplanted for the first time. The highest number of waiting or transplanted patients was blood group O. 7. A significantly greater proportion of sensitized patients with blood groups A and B was waiting than those with blood type O. The type O patients were transplanted at the same rate as they entered the waiting list. It is possible that sensitized type O patients were being discouraged from entering the waiting list. 8. A significantly smaller proportion of broadly sensitized SLE patients was waiting for a first transplant since 1988, although SLE patients were more broadly sensitized compared to those with other diseases and waiting since 1981 to 1987. This further confirms that many SLE patients are transplanted, as their sensitization is more often associated with autoantibody. 9. The highest proportion of currently sensitized recipients occurred in the transplants with 0 mismatches for the HLA-A,B specificities of the donor kidney.(ABSTRACT TRUNCATED AT 400 WORDS)