Objectives: A number of prediction factors on the outcome of cadaver renal transplants have been recognized, particularly the influence of recipient response to the first graft. However, the influence of HLA compatibility and of repeated recipient and donor antigen mismatches remain a controversy. The importance of the foregoing on the survival of the second renal graft is analyzed in this study.
Methods: The clinical records of 80 patients who had undergone a second cadaver renal transplantation from 1985 to 1995 at the Hospital 12 de Octubre (Madrid, Spain) were reviewed. Data on the recipient, donor and graft characteristics and outcome of the first and second transplants were collected for multivariate analysis of graft survival using the Cox regression method. The importance of the overall HLA compatibility and of each HLA locus, and the effect of antigenic re-exposure on the survival of the second renal graft were analyzed.
Results: The multivariate analysis showed a significant increase of the survival of the second graft when there were at least three compatible antigens between donor and recipient (p = 0.02). Compatibility of the HLA-A and DR loci appeared to improve the outcome, although the differences were not statistically significant. However, a significant improvement in the survival of the second cadaver renal allograft was found for repeated HLA mismatches between the recipient and donors (p = 0.006).
Conclusions: Our data corroborate the benefits of assigning renal grafts according to the degree of HLA compatibility also for the second renal transplant. Furthermore, our data show that re-exposure to previous mismatched antigens need not be hazardous for the second renal transplant in the cyclosporine era.