Ischemia times and donor serum creatinine in relation to renal graft failure.
BACKGROUND
The results of renal transplantation are dependent on many variables. To simplify the decision process related to a kidney offer, the authors wondered which variables had the most important influence on the graft failure risk.


METHODS
All transplant patients (n=1,124) between January 1981 and July 2000 were included in the analysis (2.6% had missing values). The variables included were donor and recipient age and gender, recipient original disease, race, donor origin, current smoking, cardiovascular disease, body weight, peak and current panel reactive antibody (PRA), number of preceding transplants, type and duration of renal replacement therapy, and time since failure of native kidneys. Also, human leukocyte antigen (HLA) identity or not, first and second warm and cold ischemia times, left or right kidney and fossa, donor kidney anatomy, donor serum creatinine and proteinuria, and transplantation year were included.


RESULTS
In a multivariate model, cold ischemia time and its time-dependent variable significantly influenced the graft failure risk censored for death (P<0.0001) independent of any of the other risk factors. The influence primarily affected the risk in the first week after transplantation; thereafter, it gradually disappeared during the first year after transplantation. Donor serum creatinine also significantly influenced the graft failure risk in a time-dependent manner (P<0.0001). The risk of a high donor serum creatinine is already enlarged in the immediate postoperative phase and increases thereafter; the curve is closely related to the degree of the elevation. The other variables with a significant influence on the graft failure rate were, in order of decreasing significance, recipient age, donor gender, donor age, HLA identity, transplantation year, preceding transplantations, donor origin, and peak PRA.


CONCLUSIONS
Donor serum creatinine and cold ischemia time are important time-dependent variables independently influencing the risk of graft failure censored for death. The best strategy for improving the results of cadaveric transplantations is to decrease the cold ischemia time and to allocate kidneys from donors with an elevated serum creatinine to low-risk recipients.
Roodnat
J I
JI
Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands. roodnat@inw1.azr.nl.
Mulder
P G H
PG
Van Riemsdijk
I C
IC
IJzermans
J N M
JN
van Gelder
T
T
Weimar
W
W
D000328:Adult; D003080:Cold Temperature; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007511:Ischemia; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009926:Organ Preservation; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D017211:Treatment Failure
D003404:Creatinine