Effect of warm ischemia time and HLA (A and B) matching on renal cadaveric graft survival and rejection episodes.
In a retrospective single-center study the influence of warm ischemia time and simultaneous influence of HLA (A and B) matching on one-year renal graft survival was analyzed in 170 adult recipients of primary cadaveric renal grafts. One-year survival of grafts with warm ischemia times longer than 50 min was only 40% (n = 10). When warm ischemia time was shorter than 50 min, a 1-min increase of warm ischemia time correlated with 1% decrease in one-year graft survival as a result of rejection. This detrimental effect of warm ischemia time on graft survival was not yet significant one month after transplantation, but became more evident as follow-up time was lengthened. Warm ischemia time also correlated with the number of reversible rejection episodes in patients with a graft functioning for longer than one year (P less than 0.04). The beneficial influence of HLA (A and B) matching on one-year graft survival was significant (P less than 0.05 log linear test). This influence was even more evident with longer warm ischemia times. It is concluded that warm ischemia has a detrimental influence on graft survival that is mediated by rejection, and it is suggested that this might be due in part to altered presentation or expression of HLA-antigens of ischemically damaged kidney tissues.
D000328:Adult; D001831:Body Temperature; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007511:Ischemia / Q000276:immunology* / Q000503:physiopathology; D016030:Kidney Transplantation; D013997:Time Factors
D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens