Factors influencing cadaver kidney transplantation outcome in the cyclosporine era. The North Italy Transplant Program (NITp).
In order to evaluate if cyclosporine (CsA) had changed the weight of some factors previously considered to influence kidney graft outcome in conventionally immunosuppressed patients, analyses of patient survival and graft survival and function were carried out on 1,105 consecutive cadaver kidney transplants, all treated with CsA, performed in the NITp between February 1983 and January 1988. Moreover, in order to compare multicenter and single center results the 344 transplants performed at the NITp's largest center were also analyzed separately. No differences were observed between the results of the single center and multicenter analyses, both indicating the following: 1. Graft survival of first transplants at 2 years was 14% higher than that of regrafts (80.1% vs 65.9% p = 0.002). As regards kidney function, regrafted patients had equivalent serum creatinine levels and number of rejection episodes as first graft recipients but received a significantly greater number of steroid pulses. 2. Patients who received kidneys with a long CIT (CIT greater than 24 hours) had a lower patient and graft survival and received steroid pulses more frequently than the other patients. 3. A transplant center effect was observed, probably due to differences in pretransplant clinical conditions of the patients and/or their posttransplant management. 4. Immunized patients (PRA greater than 50%) had a lower, although not statistically significant, graft survival than the other patients. A higher proportion of them received a greater number of steroid pulses than nonimmunized recipients. 5. HLA-A,B match appeared to have no influence on patient and graft survival or kidney function. However, it is still a useful criterion for organ allocation and makes the identification of compatible organs for retransplants and immunized recipients easier. 6. Pretransplant blood transfusions had no effect on patient and graft survival. A higher proportion of nontransfused patients showed elevated serum creatinine levels at the first posttransplant month compared with transfused patients, but due to the risks of homologous transfusions this finding does not justify pretransplant blood transfusions for the purpose of conditioning the recipient. It is concluded that of the factors considered, graft number, CIT, transplant center, and, to a lesser extent, PRA influenced patient and graft survival and/or function in CsA-treated patients, while little or no effect was attributable to pretransplant blood transfusions and HLA-A,B matching.
D000206:Actuarial Analysis; D000328:Adult; D001803:Blood Transfusion; D003524:Cyclosporins / Q000627:therapeutic use*; D004341:Drug Evaluation; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality; D009926:Organ Preservation; D010043:Outcome and Process Assessment, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate
D003524:Cyclosporins; D007166:Immunosuppressive Agents