Important risk factors of allograft survival in cadaveric renal transplantation. A study of 426 patients.
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.
Diethelm
A G
AG
Department of Surgery, University of Alabama School of Medicine, Birmingham 35294.
Blackstone
E H
EH
Naftel
D C
DC
Hudson
S L
SL
Barber
W H
WH
Deierhoi
M H
MH
Barger
B O
BO
Curtis
J J
JJ
Luke
R G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D044383:Black People; D002102:Cadaver; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D015235:HLA-B Antigens; D006684:HLA-DR Antigens / Q000032:analysis; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D044465:White People
D000911:Antibodies, Monoclonal; D006680:HLA Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens