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A retrospective investigation was carried out to evaluate the infuence of HLA (A, B) matching, blood transfusions, and preexistence of lymphocytotoxic antibodies on the outcome of the cadaver kidney graft: only non-NIH standard antibodies were considered, since patients with NIH standard antibodies do not undergo transplantation in the programme of Milano. It was found that (1) about one-half the patients with transplants had antibodies in their pretransplant serum. The preexistence of antibodies directed against B lymphocytes had an unfavourable effect on the graft survival; (2) the graft did particularly well in the nonimmunized patients who had been previously transfused; the graft survival was about 80% at 3 years in these patients; and (3) the HLA (A, B) match influenced the graft survival only in patients with antibodies.

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.