A multi-factor analysis of kidney graft outcomes at one and five years posttransplantation: 1996 UNOS Update.
1. GENERAL: Here we updated our analysis of the UNOS Kidney Registry for the compound effects of 26 transplantation factors on graft survival within 2 consecutive posttransplantation risk periods. During the early risk period, 83,867 kidney-only recipients were followed through one year, and, in the second (chronic) risk period, 66,358 recipients whose grafts survived beyond one year were followed for 5 years after transplantation. 2. SHORT-TERM EFFECTS: From the analysis, the top (< 2% of assignable variation) factors influencing one-year graft survival rates were ranked as follows: 1) living-related and living-unrelated donor transplants were preferred; 2) some transplant centers had outstanding results; 3) kidneys from stroke victims displayed poor results; 4) recipients with PRA > 80% demonstrated poor survival; 5) patients transplanted before 1991 had poor results; 6) increasing numbers of HLA-ABDR mismatches decreased survival; 7) cold ischemia times beyond 24 hours diminished survival; 8) kidneys from younger and older donors impaired survival; 9) regrafting was detrimental, 10) Asians and Hispanics enjoyed superior results; 11) recipients with restricted activities pretransplantation were at higher risk of early graft failure; and 12) high (> 30 kg/m2) body mass recipients demonstrated lowered rates. 3. LONG-TERM EFFECTS: Fewer net factors influenced graft survival beyond 1 year through 5 years. The following 9 factors, each explaining > 2% of the assignable variation in conditional 5-year graft survival, were ranked and yielded poor results: 1) older (> 65) donors; 2) Black recipients; 3) poor transplant centers; 4) male recipients; 5) kidneys from cadaver or living parental donors; 6) transplantation prior to 1991; 7) stroke donors; 8) non-zero HLA-AB mismatched transplants; and 9) teenage recipients. 4. IMPACT ON KIDNEY ALLOCATION: This UNOS data analysis combined with other recent multi-center studies suggest that the criteria for kidney allocation need contain just 2 components in order to maximize long-term survival-an immunologic factor (avoiding HLA mismatches) and a non-immunologic factor (a senior citizens pool to receive older donor organs).
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D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007668:Kidney; D007676:Kidney Failure, Chronic / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011247:Pregnancy; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States