Should I accept this kidney?

• Published in: Clinical transplantation 2000-02, Vol.14 (1), p.90-95
• Main Authors: Matas, Arthur J, Gillingham, Kristen, Payne, William D, Humar, Abhinav, Dunn, David L, Sutherland, David Er, Najarian, John S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiovascular Diseases; Cause of Death; Clinical death. Palliative care. Organ gift and preservation; Graft Survival; Histocompatibility; Humans; Kidney Transplantation - physiology; Medical sciences; Middle Aged; Risk Factors; Tissue Donors
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1034/j.1399-0012.2000.140117.x

Background. Transplant candidates frequently ask whether they should, based on information available at the time, accept a cadaver kidney or wait for a potentially better one.Methods. We analyzed 937 first and second cadaver transplants done between January 1, 1984 and December 31, 1997 to determine if information available at the time an offer is made could be used to predict long‐term graft survival.Results. By Cox regression, risk factors for worse long‐term graft survival were older donor age, cardiovascular or cerebrovascular cause of donor death, and delayed graft function (DGF). HLA‐ABDR mismatch was marginally significant. Whether DGF will occur is not known at the time of an offer, but risk factors can be determined; we found these to be older donor age and> 10% panel‐reactive antibodies (PRA) at transplantation (by Cox regression). Using these variables (PRA, ABDR mismatch, donor age, and donor cause of death) known at the time of an offer, we calculated the relative risk of worse long‐term graft survival for each subgroup ( Table 3 in manuscript). In general, older age and donor death from cardiovascular or cerebrovascular disease were associated with worse outcome. Kidneys from donors of