Long-term survival of kidney allografts.

1. Late graft loss rates did not improve substantially in patients with functioning grafts one or 5 years posttransplant when compared with all patients in pre-CsA kidney transplants. Graft loss rates were the same for recipients of first and regraft transplants involving cadaver donors after the first year posttransplant. 2. Long-term graft survival rates have not improved over the years to any great degree, in contrast to one-year rates. 3. The long-term patient survival rates have improved dramatically over the years for both cadaver and living donor transplants. 4. In recent transplants, zero HLA-A,B mismatched grafts appear to have an advantage in terms of long-term graft survival both with and without CsA immunosuppression. Matching for HLA-DR alone did not influence long-term graft survival rates. 5. In cadaver donor grafts, those with zero mismatches for HLA-B,DR or HLA-A,B,DR antigens had the highest long-term graft survival rates, particularly with transplants involving CsA. 6. From these long-term projections, it would seem that histocompatibility continues to exert a major influence on transplants in the CsA era. Only living-related donor or well-matched cadaver donor transplants appear likely to have high long-term graft survival rates.