Improvement of kidney transplant regraft results by using trauma death donors.

Patients who have lost a transplanted kidney are widely recognized as high-risk patients for retransplantation. We have found a profound difference in cadaver kidney regraft survival associated with the age and sex of the donor. Kidneys from male cadaver donors yielded significantly higher graft survival rates than kidneys from female donors. The difference in graft survival at one year was 7% for all first transplants (n = 2974), 14% if the recipient was sensitized, and 18% in 688 patients being regrafted. The difference was even more striking in regraft recipients of kidneys from young male donors (72% one-year graft survival) as compared with recipients of kidneys from older female donors (44% one-year graft survival). The donor age and sex effects correlated well with the cause of donor death. Young male donors accounted for 59% of trauma deaths whereas older female donors made up only 7%. Nontrauma donors, on the other hand, were 38% older female and 14% younger male. The survival of trauma-death donor kidneys in regrafted patients was 69% at one year and 37% for nontrauma donor kidneys, a 32% difference (P less than 0.001). These results indicate that regraft survival could be significantly increased through the use of cadaver kidneys from trauma death donors.