title: Factors influencing outcome after deceased heart beating donor kidney transplantation in the United Kingdom: an evidence base for a new national kidney allocation policy.
abstract: BACKGROUND
  Outcomes after deceased heart beating donor kidney transplantation are good, but survival rates vary according to a number of donor-, recipient-, and transplant-related factors. This comprehensive analysis of transplant outcomes was undertaken to inform development of a new Kidney Allocation Scheme.
  
  
  METHODS
  A complete case analysis of the outcome of kidney-only transplants in the United Kingdom, 1995 to 2001, was undertaken using Cox regression modeling. Seven thousand three hundred eighty-five (77%) of the 9585 transplants reported to the UK Transplant Registry were primary transplants in adults. Regrafts and pediatric patients (age <18 years) were analyzed separately. Transplant and patient survival over 5 years were investigated in addition to causes of prolonged cold ischemia time (CIT).
  
  
  RESULTS
  A variety of factors significantly adversely influenced kidney transplant and patient outcome, including older donor age, older recipient age, waiting time to transplant over 2 years, diabetes, and earlier year of transplant. Human leukocyte antigen mismatch and CIT were significant in analyses of transplant but not in patient outcome, and an increased graft failure rate was also identified in adolescent patients. CIT was prolonged by long-distance kidney exchanges between centers (2 hr) and reallocation of kidneys for alternative patients (7 hr).
  
  
  CONCLUSIONS
  This study identified a number of factors that influence transplant outcome after deceased heart beating donor kidney transplant in the United Kingdom. The findings suggest that the influences of human leukocyte antigen mismatch and CIT are most relevant in considering a revised kidney allocation scheme.
authors.affiliation: National Health Service (NHS) Blood and Transplant, Bristol, United Kingdom. rachel.johnson@nhsbt.nhs.uk
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Johnson
authors.forename: Susan V
authors.initials: SV
authors.lastname: Fuggle
authors.forename: John
authors.initials: J
authors.lastname: O'Neill
authors.forename: Samantha
authors.initials: S
authors.lastname: Start
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
authors.forename: John L R
authors.initials: JL
authors.lastname: Forsythe
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Rudge
mesh_terms: D000328:Adult; D002102:Cadaver; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006339:Heart Rate; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D040841:Resource Allocation / Q000379:methods* / Q000592:standards; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D006680:HLA Antigens