The UNOS Scientific Renal Transplant Registry.

1. The one-, 3-, and projected 10-year graft survival rates for the 35,741 first cadaveric transplants reported to the UNOS Registry were 81%, 69%, and 40%, respectively. The corresponding results of transplantations from parent donors were 90%, 81%, and 54%, and from HLA-identical siblings, 95%, 90%, and 74%. 2. Graft survival rates have improved significantly since the Registry began collecting data in October 1987. Between 1988 and 1991, survival of first-cadaver transplants rose from 77% to 84% (p < 0.001), while that of second transplants increased from 69% to 80% (p < 0.001). Some of the increase in graft survival rates was attributed to a 4-5% improvement in patient survival over the same interval. 3. Graft survival also improved among recipients of living-donor transplants. Overall survival increased from 88% in 1988 to 93% in 1991 (p < 0.003), although the results for 1992 suggest 92% may be a better expectation. The approximately 4% rise was distributed among recipients from each of the major donor relationships: HLA-identical siblings (3%); one-haplotype-matched siblings (8%); and parents (4%). Patient survival improved by one to 3%. 4. Transplants between spouses and those between distant relatives or other unrelated donors yielded excellent results. Graft survival rates at one and 3 years for 284 spousal-donor transplants were 92% and 85%, respectively. The corresponding results for 533 patients transplanted from distant relatives or other living donors were 91% and 84%. In each case, the results were higher than those for transplants from parents to their children (though the difference was not statistically significant). 5. Antilymphocyte antibodies (ALG/ATG/OKT3) given prophylactically resulted in up to a 4% improvement in graft survival rates for recipients of first-cadaver transplants. Patients who received a kidney mismatched at one or 2 HLA antigens had a 2-10% higher graft survival rate each year than those mismatched at 5 or 6 antigens. 6. HLA matching resulted in higher graft survival rates for Whites, Blacks, and Asians. Among Whites, where there was a large number of well-matched transplants, 3-year graft survival was 84% with no mismatches, and 75%, 71%, and 67%, with one or 2, 3 or 4, and 5 or 6 mismatches, respectively. Each decrease in 3-year survival was significant (p < 0.001). Among Blacks and Asians, the rankings showed a similar trend although the number of well-matched patients was small in each race.(ABSTRACT TRUNCATED AT 400 WORDS)