Cadaveric renal transplantation against a positive historic crossmatch under tacrolimus immunosuppression: long-term follow-up.

THE LONG-TERM results of transplantation against a true positive historic crossmatch due to IgG alloantibody are unclear. Tacrolimus is a novel immunosuppressive agent that has been found to be safe and effective in renal transplantation. l We report herein our long-term experience with 47 patients (mean age 41.8 :!: 14.3 years) who underwent cadaveric renal transplantation against a positive historic-current negative T-cell crossmatch under tacrolimus immunosuppression. There were 24 (51%) primary and 23 (49%) retransplants. In 18 patients the cross match remained positive with dithiothreitol (DIT), including 10 (44%) of the retransplants and eight (35%) of the primary recipients. With a median follow-up of 45.2 months, the overall patient and graft survival rates are 89.4% and 64%, and the 2-year actuarial survival rates are 89.4% and 74.5%. The overall graft survival rates were similar (P = NS) for the DIT-positive and DIT-negative patients (66.7% versus 62.1%) and primary and retransplant recipients (62.5% versus 65.2%). Of the nine patients who lost their previous graft to rejection, six currently have a functioning graft. Twenty-seven (57%) patients had at