Important risk factors of allograft survival in cadaveric renal transplantation: a study of 426 patients

• Published in: Annals of surgery 1988-05, Vol.207 (5), p.538-548
• Main Authors: DIETHELM, A. G, BLACKSTONE, E. H, NAFTEL, D. C, HUDSON, S. L, BARBER, W. H, DEIERHOI, M. H, BARGER, B. O, CURTIS, J. J, LUKE, R. G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; African Continental Ancestry Group; Aged; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Cadaver; Child; European Continental Ancestry Group; Female; Graft Rejection; Graft Survival; Histocompatibility Testing; HLA Antigens - analysis; HLA-B Antigens; HLA-DR Antigens - analysis; Humans; Immunosuppression - methods; Kidney - immunology; Kidney Transplantation; Male; Medical sciences; Middle Aged; Organ Preservation; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Transplantation, Homologous
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-198805000-00008

Multiple risk factors contribute to the allograft survival of patients who have cadaveric renal transplantation. A retrospective review of 19 such factors in 426 patients identified race, DR match, B + DR match, number of transplants, and preservation time to have a significant influence. The parametric analysis confirmed the effect to be primarily in the early phase, i.e., first 6 months. All patients received cyclosporine with other methods of immunosuppression resulting in an overall 1-year graft survival rate of 66%. The overall 1-year graft survival rate in the white race was 73% and in the black race was 57% (p = 0.002). Allograft survival and DR match showed white recipients with a 1 DR match to have 75% survival at 1 year compared with 57% in the black patient (p = 0.009). If HLA B + DR match was considered, the white recipient allograft survival increased to 76%, 84%, and 88% for 1, 2, and 3 match kidneys by parametric analysis. Patients receiving first grafts had better graft survival (68%) than those undergoing retransplantation (58%) (p = 0.05). Organ preservation less than 12 hours influenced allograft survival with a 78% 1-year survival rate compared with 63% for kidneys with 12-18 hours of preservation. Despite the benefits of B + DR typing, short preservation time, and first transplants to the white recipient, the allograft survival in the black recipient remained uninfluenced by these parameters.