An analysis of the United States renal transplant patient population and organ survival characteristics: 1977 to 1980.

This study examines the relationship between renal transplant organ survival and the extent of HLA (human leukocyte antigen) A and B loci antigen matching. Combined dialysis and transplant records for patients in the End Stage Renal Disease Medical Information System (ESRD MIS), 1977 to 1980, were analyzed to examine transplant organ survival characteristics and changes in demographic pattern and donor types compared to previously reported studies of the United States transplant patients. Actuarial survival curves for high match (3 or 4 HLA A and B loci antigen matches) versus low match (0, 1, or 2 HLA A and B loci antigen matches) groups were analyzed for their relative difference and its statistical significance. In addition, this relationship was analyzed with controls for age, sex, race, mixed lymphocyte culture (MLC), crossmatch, and prior time on dialysis. For both cadaver and living related donor transplants, statistically significant differences were found between the survival curves of high and low match groups. Comparing low match and high match groups, there were differences in 1-year organ survival of 4.8 and 11.3%, respectively, for cadaver and living related donor transplants. MLC negative and crossmatch positive status appear to improve transplant organ survival beyond the effects of HLA matching. The study also designates several methodological problems inherent in transplant organ survival studies including: whether or not to include patient deaths as therapeutic failures, and whether or not to analyze transplant organ survival at one point in time or to compare overall survival curves for the entire study period.