*Purpose: The Human Organ Transplant Act in Taiwan was promulgated in 1987 and, thereafter, organ transplantation from brain-dead donors legalized. To review the results of renal transplantation after the act, a retrospective cohort study was conducted in the first 1000 cases performed in one single hospital. Prognostic factors for graft survival were assessed with emphasis on the impact of detection and desensitization of donor-specific antibody (DSA).

*Methods: Between January 1988 and April 2014, there were 1000 cases of renal transplantation performed in National Taiwan University Hospital. Excluding 30 patients of ABO-incompatible (ABO-i) transplantation, we reviewed 970 cases of ABO compatible renal transplantation to analyze the prognostic factors for graft survival. The patients were grouped according to the dates of operations before (Early group: 503 cases) and after (Late group: 467 cases) our first ABO-i transplantation in 2004, when the protocol for detection and desensitization of DSA was implemented. Of the Late group, 22 patients received live-donor transplantation with DSA and pre-transplant desensitization.

*Results: The 1-year rejection-free rate of the Early group (78.3%) was significantly lower than that of the Late group (91.2%)(p = 0.0165), and so was the 5-year graft survival rate (79.2% vs. 86.3%)(p = 0.0012). However, when graft survivals beyond 12 months were analyzed, the difference between the two groups became insignificant. A multivariate Cox’s regression model identified more HLA mismatches, antibody-mediated rejection (AMR) and initial (or primary) non-function as significant factors for poor graft survival.

*Conclusions: Detection and desensitization of donor-specific antibody reduces risk of early but not late renal transplant failure. HLA mismatch, AMR and initial (or primary) non-function remained to be significant factors for poor graft survival.

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