title: Factors associated with primary and secondary graft failure following cadaveric kidney transplant.
abstract: The risk profile for primary renal graft failure is largely unknown because of its inclusion with secondary failures or its exclusion from analysis. This study compares characteristics of the cadaveric transplant recipients who experienced primary failure, secondary failures or survived with a functioning graft for at least 6 months. Medical records of all cadaveric kidney-transplant patients performed in Israel over a 3-yr period 1997-2000 were reviewed. Fisher's exact test and multinomial regression models were used to assess the association of demographic, pre-operative and operative risk factors with the two types of failure outcomes. Of 325 grafts, 54 (16.6%) failed of which half were primary failures. Univariate analysis demonstrated a significant trend of increasing proportion of patients with specific risk factors from the functioning grafts group to the secondary and to the primary graft failure groups. Independent risk factors for primary graft failure included 'surgical complications', 'donor's age > or =60 yr', 'waiting for transplant > or =6 yr', and 'human leukocyte antigen-DR (HLA-DR) mismatch', based on the multivariate model. These factors may reflect the scarcity of organ donations in Israel, which leads to a prolonged waiting time, higher tolerance for HLA-DR mismatches, and utilization of kidneys from elderly donors.
authors.affiliation: The Department of Health Services Research, Ministry of Health, Jerusalem, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Weiss-Salz
authors.forename: Micha
authors.initials: M
authors.lastname: Mandel
authors.forename: Noya
authors.initials: N
authors.lastname: Galai
authors.forename: Irit
authors.initials: I
authors.lastname: Nave
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Boner
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.forename: Elisheva
authors.initials: E
authors.lastname: Simchen
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002102:Cadaver; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006684:HLA-DR Antigens / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D007431:Intraoperative Complications; D016030:Kidney Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
chemical_list: D006684:HLA-DR Antigens