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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. One-year graft survival rates were 80%, 74%, and 66% for recipients of first (27,755), second (4,263), and multiple (914) cadaveric renal transplants, respectively. The 1-year patient survival rate was 94% for recipients of first or second grafts and 92% for multiply retransplanted patients. Half-lives projected for all cadaver transplants surviving the first year were approximately 8 years. 2. One-year graft survival rates were 95% for recipients of HLA-identical sibling-donor transplants (1,493), 91%, 90%, and 89% for recipients of 1-haplotype-matched sibling (1,787), parent (2,118), and offspring (715) donor grafts, respectively. One-year patient survival was 94% for parents receiving transplants from their children and 98% for all other recipients of kidneys from immediate family members. Projected half-lives were 26 years for HLA-identical grafts and 12-14 years for 1-haplotype-mismatched transplants from living related donors. 3. There were 181 transplants between spouses, with a 1-year graft survival rate of 92% and 99% patient survival. There were also 369 transplants from distant relatives or unrelated living donors with a 1-year graft survival rate of 86% and 95% patient survival. Projected half-lives for these transplants were 13 years. 4. Rejection episodes that occurred during the initial transplant hospitalization were reported in 24% of first and 33% of retransplanted recipients (p < 0.001). Rejection-free patients had an 85% 1-year graft survival rate compared with 67% and 58% in recipients of first or regrafts after early rejection (p < 0.001). Rejection episodes were strongly associated with histoincompatibilities. Among HLA-identical sibling transplants, 6% had early rejection compared with 12% of HLA-A,B,DR-matched cadaver transplants, 25% of parent-donor transplants and 28% of HLA-DR-mismatched cadaveric transplants. 5. The serum creatinine level (SCr) reported at the time of discharge was predictive of graft survival in both the short and long term. Recipients of first cadaver transplants discharged with SCr below 1.6 mg/dl (8,960) had a 91% 1-year graft survival rate and a projected half-life of 12 years, while those with SCr above 3.5 mg/dl had 49% 1-year graft survival and 5.3-year projected half-life (p < 0.001). Discharge SCr was significantly influenced by the recipient's weight, the donor's age, and the cold ischemia time.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The UNOS Scientific Renal Transplant Registry. 130 88

1. From a multivariate log-linear analysis of 35,625 renal transplants between 1988 and 1991, center effects accounted for 28%, 45%, and 27% of all assignable variation in 3-month, 1-year, and 2-year outcomes, respectively. Although center variation dominated 22 other variables, most factors were relatively independent of transplant center (ie, a percent of factor variation due center less than 10%). Recipient race and health status were notable exceptions; both highly influenced by center affiliation. Centers also differed in the age mix of recipients and racial mix of donors in some epochs. Again, we found only extremely weak correlations among a center's 3-month, 1-year, and 2-year graft survival rates. 2. In order of 3-month accountability, the other important factors were PRA, donor age, recipient working status, year of transplant, HLA-A,B mismatching, previous transplant, donor's death, donor relationship, recipient race, body mass, recipient age, cold ischemia time, donor race, donor kidney mode (ie, left/right kidney), original disease, and HLA-DR mismatching. Regarding 1-year outcome, the important factors were recipient race, donor age, donor's death, donor relationship, HLA-A,B mismatching, previous transplant, and recipient sex. Finally at 2 years, the important factors were recipient race, donor age, year of transplant, donor relationship, recipient sex, working status, donor's death, recipient age, CMV status, body mass, and donor sex. 3. Body mass, donor kidney mode, and CMV status were novel factors in our own multifactorial analyses of the UNOS Registry file. An elevated body-mass index (> 30 kg/m2) had a negative impact on short- and long-term graft survival. Recipients receiving left kidneys had nominal improvement in 3-month graft survival, but no impact thereafter. Survival rates over the 4 combinations of donor/recipient CMV statuses, suggest that this covariate was principally long-term and donor related. 4. It is noteworthy that graft failures in the 2 most recent transplant years, 1990 and 1991, have shown both short- and long-term declines, breaking stationary patterns previously reported in this series on clinical transplants. 5. The transitory nature of most transplantation factors was confirmed in this study, implying that future multifactorial studies in renal transplantation must include some mechanism for varying risks.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Multifactorial analysis of renal transplants reported to the United Network for Organ Sharing Registry. 130 7

1. In 1966, the half-life (1-year posttransplantation) for first cadaver-donor kidney grafts reported to the UCLA Registry was around 7.5 years (1). Between 1985 and 1990, this half-life was 7.8 +/- 0.02 years. Since 1966, the corresponding 1-year graft survival rates increased by over 30 percentage points. Clearly, improvement in early graft survival has had little bearing on long-term graft outcome. 2. From a stratified multivariate analysis of 40,582 primary cadaveric renal transplants recorded in the UCLA Transplant Registry from 3 consecutive eras (1975-79, 1980-84, 1985-90), the following long-term graft survival trends in covariates have emerged: a) a constant strong negative effect associated with higher numbers of HLA-A,B mismatches, younger and older recipients, diabetics, and longer cold ischemia times in each era; b) an increased beneficial effect on female recipients; c) an increased detrimental effect on Black recipients, despite short-term gains; and d) a positive effect of CsA usage (only in the most recent era). 3. From a multivariate analysis of 15,027 primary cadaveric renal transplants reported to the UNOS Kidney Registry between 1987 and 1990, we analyzed the effects of transplantation factors on survival during 3 consecutive posttransplantation risk periods: 0-1 month; 1-3 months; and beyond 3 months. Few pretransplant factors affected risk of failure within 1-month posttransplantation. However, a good predischarge clinical course (as indicated by CsA usage, no required dialysis during the first postoperative week, and no rejection episodes) was associated with an immediate improvement in graft survival. The effects of most UNOS transplantation factors during the second risk period were comparable to the short-term coefficients estimated from the UCLA file; and the effects of the UNOS factors on "beyond 3-month" risk were comparable to the UCLA long-term coefficients. Conclusively, the dominant pretransplant factor on long-term risk was HLA-A,B tissue matching.
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PMID:Survival trends in long-term first cadaver-donor kidney transplants. 182 Jan 18

1. From a multivariate log-linear analysis of 30,274 renal transplants between 1985 and 1989, center effects accounted for nearly 30% of all assignable variation in 1-year outcome, dominating 15 other factors analyzed. In order of accountability in 1-year graft outcome, the other important factors were donor relationship, CsA usage, donor age, graft number, highest pretransplant antibody, recipient race, HLA-A, B, and DR mismatches, cold ischemia time, donor sex, donor race, and pretransplant transfusions. Original disease, transplant year, recipient sex and age were not significant factors influencing 1-year graft survival. 2. The additive nature of these transplantation factors on the logit scale was confirmed in this analysis, implying that univariate analyses in renal transplantation are not necessarily improper. 3. There was no correlation between center effect and center size as measured by the number of renal transplants per year. Therefore, renal transplantation at small centers will not necessarily produce poorer graft function. 4. Similarly, we found only weak correlation between a center's 1-year graft survival and their patients' graft half-lives beyond 1-year. This suggests that factors determining center success in early graft survival differ from those that influence long-term success. 5. Graft survival rates among patients with and without rejection episodes prior to hospital discharge vary substantially among centers. Centers with poor 1-year graft survival demonstrated a significantly larger variation in graft survival between their patients with and without rejection than did excellent, good, and fair centers. This indicates that posttransplant patient maintenance is another factor influencing center effects on renal graft function.
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PMID:Update: center effects. 210 59

1. Among patients transplanted in 93 selected centers with good follow-up data, the 10-year graft survival of first cadaver-donor transplants was 18%, parental donor grafts 39%, and HLA-identical sibling donor grafts 66%. The respective half-lives were 6.8, 10.8, and 24.5 years. The donor relationship has been the most important factor in long-term success. 2. Patient half-life for recipients younger than 16 was 36 years; for recipients 16-50 years old it was 17.6 years, and for those over age 50, it was 10.4 years. This marked difference in patient half-lives severely affected functional graft half-lives for the 3 age groups; 6.8, 10.3, and 16.7 years, respectively. However, the differences in patient survival for the 3 age groups were not significantly reflected in graft half-lives that were 6.8, 7.7, and 6.5 years, respectively. Thus, graft loss resulting from rejection was significantly lower in older than in younger patients. 3. Cadaver-donor kidneys with cold ischemia time up to 12 hours and half-lives of 9.1 years in transplants performed before 1975, compared to half-lives of 6.4 years for those with more than 24 hours cold ischemia time. In transplants performed between 1980 and 1983, the half-life of kidneys with cold ischemia time up to 12 hours was 8.7 years, compared to 6.9 years for those with more than 24 hours cold ischemia time. The long-term effect of cold ischemia persists but has diminished in recent years. 4. HLA-A,B loci matching had a significant effect on long-term graft survival. The 10-year graft survival of A,B matched grafts was 30% compared to 18% for 3 or 4 HLA-A,B mismatched transplants. This difference increased at 15 years to 25% in the matched grafts and 10% in the mismatched grafts. 5. A very strong recipient race effect was evidenced by the 24% 10-year graft survival in Whites compared to 10% in Blacks. The half-lives were 8.2 in Whites and 4.8 in Blacks. 6. A listing of 15-year graft survivors has been compiled according to transplantation centers. There was a total of 969 from cadaver donors, 283 from parental donors, and 457 from sibling donors. 7. An analysis of the characteristics of the 15-year graft survivors showed a preponderance of patients with favorable factors, noted in the analysis above. As might be expected, the most striking was the fact that 27% of the 15-year survivors had received kidneys from sibling donors, despite the fact that such donors comprised only 17% of those transplanted in the pre-1975 era.
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PMID:Fifteen-year kidney graft survival. 248

1. In the long-term period, the half-life effectively measured loss rate. For HLA-identical sib donors the half-life was 25 years; for parental donors, 13 years; and for cadaver donors, 8 years (now possibly 11 years). 2. HLA-A,B,DR matching exerted the greatest effect on half-life, for a half-life of 17 years was achieved for cadaver donors. This rate was not quite as high as that for A,B,DR matched siblings but was higher than the one haplotype mismatched parental donor transplants. 3. Caucasian recipients had a half-life of 8 years compared to 5 years for black recipients. 4. Excellent centers had a 10-year half-life compared to 5 years for fair centers. 5. Cold ischemia time over 24 hours, recipient age over 55, and donor age of 50-60 had a small effect on the half-life in the order of 1 to 3 years. 6. Among the short-term factors that affect the 1-year graft survival, there was a 12% difference between excellent and fair centers. An 11% difference between A,B,DR matched transplants and 6 A,B,DR mismatched grafts was noted. First-cadaver donor grafts had a 10% higher graft survival at 1-year than second grafts. Other factors together with the difference in 1-year graft survival between the extremes were as follows: sensitization 9%, race 8%, transfusion 6%, donor age 6%, diabetic 3%, recipient age 3% and cold ischemia 1%. Thus more factors affect short-term survival than long-term survival.
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PMID:Long-term survival of kidney grafts. 265 Feb 6

To avoid the center effect and the possible hidden interactions of multicenter studies, the validity of the Cox Proportional Hazards Model for the analysis of a single-center kidney transplant program was tested, considering 287 renal transplants performed in a 10-year period. The inclusion of type of donor and main immunosuppressive drug as covariates in the model did not violate the proportionality assumption of the Cox model. According to this method, the following covariates were significant in predicting graft survival: cyclosporine, type of donor, good human leukocyte antigen (HLA)-A and HLA-B match (DR data were not considered), highest percentage of reactive antibodies against panel cells, and nephroangiosclerosis as a primary renal disease. Cyclosporine did not significantly improve graft survival in living related donor transplants. Pretransplant blood transfusions, cold ischemia time, and donor ABO blood group were initially significant but dropped out in the step-down procedure. Recipient's age at transplant, cyclosporine, HLA-A and HLA-B match, and nephroangiosclerosis were significant in predicting patient survival. It was concluded that using long-term data of cadaveric and living related renal transplants either on azathioprine or cyclosporine is a valid way to perform multivariate analysis of single-center transplant programs that do not have large samples.
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PMID:An alternative approach for statistical analysis of kidney transplant data: multivariate analysis of single-center experience. 305 83

We reviewed 14,005 renal grafts with the temporal opportunity for 10-year survival (transplanted 1975 and earlier) and analyzed 10-year actuarial graft survival and the rate of late (3- through 10-year) graft loss as reflected by half-life. The 10-year graft survival for first transplants in HLA-identical siblings was 67% versus 38% for parental donors and 20% for cadaver donors. Factors with substantial influence on 10-year graft survival include transplant number, transfusions (0, 17%; greater than or equal to 1,33%), HLA-A,B mismatches (0, 29%; 1-2, 20%, 3-4, 17%), cold ischemia time (0-3 hours, 32%; 4-6 hours, 27%; 7-12 hours, 21%; greater than 12 hours, 16%), preservation method if CIT is no more than 24 hours (cold storage, 22%; machine, 17%), recipient race (Caucasian, 23%; black, 11%), original disease, recipient age, recipient sex, donor race, and the quality of early graft function (less than or equal to one month). Factors not significantly influencing 10-year graft survival were panel-reactive antibodies, warm ischemia time, preservation method if CIT was more than 24 hours, and donor sex.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Factors important in 10-year kidney transplant survival. 315 94

The salient features of one-year regraft transplant survival are as follows: 1. The effect of cyclosporine is less (about 7% increase in one-year graft survival) on regrafted patients than on first grafts. 2. In general we saw a HLA antigen matching effect in cyclosporine- and noncyclosporine-treated retransplant patients. 3. Patients who received living-related HLA two-haplotype matched kidneys did equally as well as a first or regraft recipient. 4. Transfusions seemed to have a minimal effect on regraft survival. 5. It is more important to match in patients who have PRA and the matching benefits translate into 61% and 75% one-year graft survival for zero DR and zero B,DR mismatched regraft patients, respectively. 6. In regrafts, female donor kidneys resulted in 15% lower one-year graft survival than male donor kidneys. 7. Retransplant patients from fair centers showed a significant 13% increase in one-year graft survival with cyclosporine. 8. Cold ischemia time, diabetes, and kidneys used locally or shipped had little effect on the regraft one-year survival. 9. The initial function of the retransplant kidney had a very large effect on the final one-year graft outcome of that kidney and was independent of the use of cyclosporine patients having a functioning kidney at one month had 75% and 72% one-year regraft survival with and without cyclosporine treatment, respectively. Patients having a nonfunctioning kidney at one month had 5% and 8% one-year regraft survival with and without cyclosporine treatment, respectively. 10. Responder and nonresponder classifications as defined by the duration of the first graft resulted in a 10 to 15% difference in regraft survival. 11. The effect of HLA-A,B matching was very strong in responder patients, i.e., there was a 32% difference in one-year regraft survival between zero mismatch and more than two antigens of mismatch. In nonresponder patients, the effect of HLA-A,B matching was only 5%. For HLA-DR locus matching, the difference was 12% for responders and 6% for nonresponders. 12. Cyclosporine use showed about a 10% increase in graft survival in responders and nonresponders. 13. Responder classification was also possible by separating patients who had initial function but no function at one month (responders) from those with function at one month (nonresponders).
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PMID:Regraft kidney transplant survival. 315 19

NITp is an organization that since 1972 has served an area of approximately 17 million inhabitants through 8 transplant centers, 20 active donor-procuring centers, and 1 coordinating center. The activity of NITp can be divided into three historical periods. In the first period (1972-1977, 408 transplants), collaboration was initiated and protocols implemented. In the second (1978-1982, 592 transplants), a policy was established as follows: three deliberate transfusions of standard packed red cells were given pretransplant to all untransfused patients on the waiting list. Priority was given to immunized patients when an HLA-A, -B-compatible kidney was available and an effort was made to ensure at least two HLA-A, -B matches to nonimmunized patients. All transplanted patients were treated with conventional therapy (corticosteroids and azathioprine). Evaluation of data of this period showed that both graft and patient survival had increased; a center effect was evident; the policy of giving a kidney with at least two HLA-A, -B matches seemed to improve the results; and preformed panel-reacting antibodies had a negative effect on graft survival. The third period began in January 1983 when some centers in the NITp started to use CsA. By December 31, 1985, 589 of 863 transplants performed had been treated with CsA. Data analysis showed that CsA significantly increased the one-year success rate in both first and second transplants; other factors, such as HLA-A, -B and -DR matching, transplant center, old age of the kidney donor (51-60 years), and cold and warm ischemia times seemed less or not important. Preformed panel-reacting lymphocytotoxic antibodies did not influence graft outcome significantly, but a trend was observed in that immunized recipients did worse than non-immunized recipients. The transfusion effect could not be evaluated in our CsA patients since they all are transfused pretransplant; a prospective study is necessary to evaluate if such an effect is still present. Until more data are collected in our setting to allow a sound evaluation of the consequences of CsA treatment, no changes are warranted in the NITp policy.
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PMID:The cadaver kidney transplant program of North Italy before and after cyclosporine. 315 52


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