title: Follow-up after renal transplantation with organs from donors after cardiac death.
abstract: Kidneys obtained from donors after cardiac death (DCD) are known to have higher rates of primary nonfunction and delayed graft function (DGF) than heart beating cadaveric donor (CAD) kidneys, but little is known about long-term function of DCD grafts that survive to 1 year. To investigate the outcomes of renal transplant recipients whose DCD graft functioned for at least 1 year, this study analyzed data collected from 326 DCD graft recipients and 340 CAD-matched controls enrolled in a prospective, multinational, observational study--Neoral-MOST (Multinational Observational Study in Transplantation) (Novartis, Basel, Switzerland). No differences were found in the demographics or immunosuppression between the two groups. All patients received a Neoral-based immunosuppressive regimen. Donors after cardiac death graft recipients had a higher incidence of DGF (40% vs. 27% CAD; P < 0.001). One year glomerular filtration rate (GFR) and GFR-decline after 1 year were similar in DCD and CAD recipients (GFR 56 ml/min DCD vs. 59 ml/min CAD; GFR-decline -1.3 ml/min DCD vs. -1.4 ml/min CAD; P = not significant). Multifactorial analyses confirmed that GFR at 1 year was significantly influenced by donor age and gender, DGF, and acute rejection; however, DCD status was not an independent risk factor in cyclosporine-treated patients with grafts that had functioned for at least 1 year.
authors.affiliation: Renal Unit, Westmead Hospital, Westmead, NSW, Australia. jeremy_chapman@wsahs.nsw.gov.au
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
authors.forename: Andreas
authors.initials: A
authors.lastname: Bock
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Lutz
authors.initials: L
authors.lastname: Fritsche
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
authors.forename: Yvon
authors.initials: Y
authors.lastname: Lebranchu
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
authors.forename: Erich
authors.initials: E
authors.lastname: Pohanka
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvadori
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tufveson
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine