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This study was conducted to determine the efficacy of the T cell flow cytometry crossmatch (T-FCXM) test in 841 first cadaver donor transplants. Results showed one-year graft survival rates were 82% for T-FCXM-negative patients, compared with 75% for T-FCXM-positive patients (P = 0.01). Early one-month graft failure was 13 percentage points higher in those with a positive T-FCXM than those with a negative T-FCXM. The positive crossmatch patients also had more frequent immunological failures. A positive T-FCXM was found in 39% of the sensitized patients (PRA > 10%) and 8% of those who had not been sensitized. Patients with a positive T-FCXM in either category had a 74% graft survival rate. Thus, most of the T-FCXM-positive results occurred in patients with complement-fixing antibodies. It is suggested that flow cytometry crossmatching (FCXM) be used prospectively, despite the fact that many patients with a positive crossmatch did have successful transplants (TXs). In the current climate of a cadaver kidney scarcity and large recipient waiting pools, utilization of kidneys for patients with the highest probability of success seems a most prudent policy.

1. The Los Angeles Transplant Society and the Regional Organ Procurement Agency of Southern California (ROPA) was established in November 1967. ROPA was the first such organization in the United States. 2. The use of simple cold storage and shipment of kidneys by commercial airline resulted from pioneering concepts developed in the Los Angeles area from 1968-1969. 3. In the 26-year period of ROPA's operation, it has coordinated 8,446 kidney transplants. 4. All kidneys transplanted in 1993 were allocated according to the UNOS point system. 5. Allocating all kidneys under the point system has not significantly disadvantaged either large or small transplant centers in the greater Los Angeles area. 6. Racial distribution of recipients: 13% Black (compared with Los Angeles population of 12% and 6% donor population). Blacks represent 20% of the recipient waiting list. Hispanic recipients were 31% (compared to Los Angeles population of 40% and donor population of 30%). Hispanics comprised 28% of the waiting list. 7. The average waiting times for centers in the Los Angeles area ranged from 14-19.4 months. Transplanted patients waited an average of 16.3-22.1 months. 8. "Required request" had a significant effect on the number of referrals but did not produce a meaningful increase in the number of kidneys transplanted.

1. The 1,480 patients awaiting cadaveric renal transplants at 14 Southern California transplant centers as of December 3, 1992, were compared with patients transplanted using a point system for one kidney and a hospital-based allocation for the second, or the current system allocating all locally procured kidneys by the point system with regard to several demographic parameters. 2. Of 1,472 waiting patients with sensitization data, 8.5% were broadly sensitized (> 80% PRA). Of the 737 kidneys allocated by the point system, 7% went to broadly sensitized patients, compared with 3% of 438 kidneys allocated by the hospitals (p < 0.001). 3. Of 1,470 waiting patients with information available, 23% were awaiting a repeat transplant. Under the point system, 18% of kidneys were used for repeat transplants compared with 9% of hospital-allocated kidneys (p < 0.001). 4. Of 1,434 waiting patients where the time waiting was available, 26% had waited 1-2 years, 12% 2-3 years, and 6% more than 3 years. Under the point system, patients waiting longer received significantly more kidneys than those recently added to the list: 35% had waited 1-2 years, 21% 2-3 years and 14% more than 3 years (p < 0.001). Kidneys allocated by the hospitals were transplanted to patients in approximately the same proportions as the waiting list: 29% to those waiting 1-2 years, 10% 2-3 years, and 3% more than 3 years. 5. Racial distribution of recipients was not significantly different under either allocation system from that of the waiting list. Whites comprised 39% of waiting patients, the same as the population of Los Angeles County.(ABSTRACT TRUNCATED AT 250 WORDS)

1. The ultimate distribution of 479 consecutive cadaver donor kidneys in the Los Angeles area was examined to determine whether the distribution had been equitable. Half of the kidneys had been allocated by the UNOS point system (or slight modifications thereof) and half by the transplant centers according to their own criteria. 2. With respect to waiting time, the pool of 1,000 was composed of 14% patients who had waited more than 2 years. The UNOS point system forced the transplantation of more patients (27%) who had waited longer than 2 years than the nonpoint system (11%). 3. Although the waiting pool was composed of 28% waiting for retransplantation, the UNOS point system resulted in transplantation of 16% and the nonpoint system, 8%. 4. In the waiting pool, 16% of the patients had cytotoxic antibodies reactive to more than 80% of the panel, whereas 11% of the transplants by the UNOS point system were transplanted into highly sensitized patients and only 2% of the patients transplanted by the nonpoint system were highly sensitized. 5. In Los Angeles, where 11% of the population is Black, 10% of the kidneys transplanted were into Black patients. Since 18% of the waiting pool of patients were Black, some shortfall was noted. However, this can be attributed to the fact that only 7% of the donors were Black. The importance of increasing donation from the Black community is emphasized. 6. Because of the limited pool size of 1,000 patients only a small number of 0 B,DR transplants were achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

For some 20 years a coordinated arrangement for sharing cadaver organs has been in place in Southern California. It's 11 transplant centers have performed 4,947 kidney transplants from 7,480 referred donors. There were 430 transplants done in 1985. The policy has been to keep one kidney and share the other within the pool. This has resulted in a better than average level of matching for HLA, and an overall better than average graft survival. The graft survival rates at the centers have been increasing yearly. Much of the improvement in graft survival resulted from the introduction of cyclosporine, but a summation of many factors contributed to a steady yearly increase. There are some 600 patients waiting for transplantation. With greater efforts in procurement of cadaver kidneys, especially from minorities, and continued collaboration between the transplant centers, it should become possible to transplant all those who are in need of a kidney.