title: Delayed function reduces renal allograft survival independent of acute rejection.
abstract: BACKGROUND
  Mechanisms by which delayed allograft function reduces renal allograft survival are poorly understood. This study evaluated the relationship of delayed allograft function to acute rejection and long-term survival of cadaveric allografts.
  
  
  METHODS
  338 recipients of cadaveric allografts were followed until death, resumption of dialysis, retransplantation, loss to follow-up, or the study's end, which ever came first. Delayed allograft function was defined by dialysis during the first week following transplantation. Multivariate Cox proportional hazards survival analysis was used to assess the relationship of delayed allograft function to rejection and allograft survival.
  
  
  RESULTS
  Delayed allograft function, recipient age, preformed reactive antibody levels, prior kidney transplantation, recipient race, rejection during the first 30 days and rejection subsequent to 30 days following transplantation were predictive of allograft survival in multivariate survival models. Delayed allograft function was associated with shorter allograft survival after adjustment for acute rejection and other covariates (relative rate of failure [RR]+1.72 [95% CI, 1.07, 2.76]). The adjusted RR of allograft failure associated with any rejection during the first 30 days was 1.99 (1.23, 3.21), and for rejection subsequent to the first 30 days was 3.53 (2.9 08, 6.00). The impact of delayed allograft function did not change substantially (RR=1.84 [1.15, 2.95]) in models not controlling for acute rejection. These results were stable among several subgroups of patients and using alternative definitions of allograft survival and delayed allograft function.
  
  
  CONCLUSIONS
  This study demonstrates that delayed allograft function and acute allograft rejection have important independent and deleterious effects on cadaveric allograft survival. These results suggest that the effect of delayed allograft function is mediated, in part, through mechanisms not involving acute clinical rejection.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Feldman
authors.forename: R
authors.initials: R
authors.lastname: Gayner
authors.forename: J A
authors.initials: JA
authors.lastname: Berlin
authors.forename: D A
authors.initials: DA
authors.lastname: Roth
authors.forename: R
authors.initials: R
authors.lastname: Silibovsky
authors.forename: S
authors.initials: S
authors.lastname: Kushner
authors.forename: K L
authors.initials: KL
authors.lastname: Brayman
authors.forename: J E
authors.initials: JE
authors.lastname: Burns
authors.forename: S M
authors.initials: SM
authors.lastname: Kobrin
authors.forename: A L
authors.initials: AL
authors.lastname: Friedman
authors.forename: R A
authors.initials: RA
authors.lastname: Grossman
mesh_terms: D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors