title: Effect of the shipment of cadaveric renal allografts on allograft survival.
abstract: BACKGROUND
  Since 1996, the allocation of grafts in France has been based on a hierarchical three-level system: national, regional and local. The objective of this study was to determine whether the shipment of cadaveric kidneys according to these new exchange rules affects allograft outcome in the Eastern region of France.
  
  
  METHODS
  This retrospective study analysed all renal transplants performed in the four centres of the French Eastern region during 3 years (1996 to 1998). All patients were followed up until death, return to dialysis, last information date or the end of June 2003. Information regarding the donors, recipients and treatments, as well as patient and graft outcome, was recorded. Factors associated with graft loss were analysed using Cox proportional hazard methods.
  
  
  RESULTS
  542 transplants were analysed, 287 (53%) kidneys were transplanted locally, 229 (42.2%) kidneys coming from exchanges within the region and 26 (4.8%) from another region. There were statistically significant differences between the four centres for donors' and recipient' characteristics and for immunosuppressive treatment, but there was no difference between centres regarding patient survival (94.4% at 5 years), graft survival (83.7% at 5 years) or death-censored graft survival (87.8% at 5 years). Compared to locally transplanted grafts, shipped grafts had significantly better human leukocyte antigen (HLA) matching (2.5 +/- 1.3 versus 2.1 +/- 1.0 matches, P = 0.0005 but a longer cold ischaemia time (23.2 +/- 7.9 versus 19.2 +/- 7.8 h, P < 0.0001). Three independent factors were associated with a reduced graft survival: at least one acute rejection, delayed graft function and a shipped graft.
  
  
  CONCLUSIONS
  The results of this study suggest that the shipment of cadaveric renal allografts in a regional distribution system is associated with better HLA matching but is a significant predictor of graft loss at 5 years. It would be advisable to restrict graft sharing to patients whose access to transplantation is limited, taking special care to avoid any additional factors having a detrimental effect on the outcome.
authors.affiliation: Department of Nephrology, Nancy, France. m.kessler@chu-nancy.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Virion
authors.forename: Mourad
authors.initials: M
authors.lastname: Hachicha
authors.forename: Bruno
authors.initials: B
authors.lastname: Moulin
authors.forename: Olivier
authors.initials: O
authors.lastname: Toupance
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Rebibou
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D005602:France; D006084:Graft Rejection; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*; D014184:Transplantation, Homologous; D014186:Transportation