A single-center experience with six-antigen-matched kidney transplants

W. K. Washburn, D. Shaffer, P. Conway, P. N. Madras and A. P. Monaco
Division of Organ Transplantation, New England Deaconess Hospital, Harvard Medical School, Boston, Mass.

OBJECTIVES: To review our center's experience with the United Network of Organ Sharing six-antigen-matched (6-AgM) kidney program. Specifically, to determine whether recipients of 6-AgM cadaver kidney transplants have less perioperative and short-term (< 1 year) morbidity in comparison with living-related donor (LRD) recipients and a control group of immunologically less well-matched cadaver recipients. DESIGN: A retrospective review of all solitary kidney transplantations performed over a 24-month period, from 1992 to 1993. SETTING: A large urban tertiary care referral center with a long history of renal and extrarenal transplantation. PATIENTS: Adult patients receiving a solitary kidney transplant from either a cadaver or a living donor. MAIN OUTCOME MEASURES: Mortality, morbidity, and patient and graft survival. Other variables measured included rejection episodes, length of stay, readmissions, postoperative complications, waiting time, and delayed postoperative graft function. RESULTS: Recipients of 6-AgM kidney transplants were at higher risk than the control groups of cadaver and LRD recipients, with more retransplantations, higher sensitization, and more with diabetes. There were fewer rejection episodes in the 6-AgM group, and these were more steroid responsive. They had fewer hospital days (22.6 days) in the first year following transplantation, compared with the remaining cadaver group (28 days). The delayed postoperative graft function rate was also significantly lower than that of the cadaver control group. Graft and patient survival were excellent for all groups. Analysis of these factors showed similar results when comparing the LRD and 6-AgM groups and a marked improvement over the cadaver control group. CONCLUSIONS: Identical HLA matching for cadaver recipients provides superior results for graft and patient survival. There is much less perioperative morbidity in comparison with the less well-matched cadaver recipients. The effect of HLA matching is reflected in the perioperative courses of these patients, in addition to the long-term benefits of graft survival. Allograft survival is superior for this select group of cadaver recipients. The 6-AgM recipients behave similarly to LRD recipients in this cohort of patients. Our results would support the continued sharing of 6-AgM kidneys to optimize outcome and best use the limited resources available to the patients undergoing transplantation.