Cadaver-donor renal retransplants.

1. There was a dramatic improvement in survival rates for retransplanted patients between 1989 and 1991. The proportion of cadaveric kidneys used to retransplant patients has decreased from 18.4% in 1984 to 14.3% in 1992. In 1992, the 81% one-year survival rate for second transplants nearly reached that of first transplants. 2. Despite recent improvements in regraft survival, the PGST remained the strongest predictor of second graft outcome. One-year regraft survival rates were 54% when the PGST was one to 3 months and 75% when the PGST was more than one year. The steady improvement in second graft survival rates may be influenced by retransplanting more patients with a longer PGST. 3. Patients with broadly reactive anti-HLA antibodies (PRA > 50%) had 10% lower regraft survival rates than nonsensitized patients (p < 0.001). 4. A repeated HLA-DR antigen mismatch resulted in 6% and 13% lower regraft survival at one and 3 years, respectively, compared with patients who had at least one HLA-DR mismatch, but not for the same antigen mismatched previously (p < 0.05). 5. Recipients expressing HLA-DR1 had an 81% one-year second graft survival rate compared with 75% for patients lacking DR1 (p < 0.001). 6. Matching for HLA-B,DR and HLA-A,B,DR antigen combinations resulted in 80-82% one-year regraft survival rates for second and multiple transplant recipients, compared with 57-74% for completely mismatched transplants. 7. Transplants from donors under age 6 or over age 55 had significantly poorer outcomes than those involving kidneys from donors in the intermediate age range. The results of transplants at the extremes of donor age were very poor when the recipient was retransplanted. 8. Among recipients of second and multiple transplants, prophylactic OKT3 yielded 82% and 72% one-year regraft survival, respectively, compared with 75% and 66% with no antibody induction (p < 0.001 for second transplants). 9. Regraft survival rates comparable with those for primary cadaveric transplants reported to the UNOS Registry since 1991 justify the use of cadaver-donor kidneys for low-risk patients seeking second renal transplants.