title: Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany.
abstract: Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n = 4411, isolated KTX). Results. Risk factors associated with graft-survival were donor age (1.020 [1.013-1.027] per year), donor size (0.985 [0.977-0.993] per cm), donor's creatinine at admission (1.002 [1.001-1.004] per µmol/L), donor treatment with catecholamine (0.757 [0.635-0.901]), and reduced graft-quality at procurement (1.549 [1.217-1.973]), as well as recipient age (1.012 [1.003-1.021] per year), actual panel reactive antibodies (1.007 [1.002-1.011] per percent), retransplantation (1.850 [1.484-2.306]), recipient's cardiovascular comorbidity (1.436 [1.212-1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619-0.887]). Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care.
authors.affiliation: Deutsche Stiftung Organtransplantation, Region Baden-Württemberg, Kriegerstraße 6, 70192 Stuttgart, Germany.
authors.forename: Carl-Ludwig
authors.initials: CL
authors.lastname: Fischer-Fröhlich
authors.affiliation: BQS Institute for Quality and Patient Safety, Kanzlerstraße 4, 40472 Düsseldorf, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Kutschmann
authors.affiliation: MVZ Anaesthesio Nordrhein, Hans-Günther-Sohl-Straße 6-10, 40235 Düsseldorf, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Feindt
authors.affiliation: Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Schmidtmann
authors.affiliation: Medizinische Fakultät, Albert Ludwigs Universität Freiburg, Hebelstraße 29, 79104 Freiburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Kirste
authors.affiliation: Landesärztekammer Niedersachsen, Berliner Allee 20, 30175 Hannover, Germany.
authors.forename: Nils R
authors.initials: NR
authors.lastname: Frühauf
authors.affiliation: Deutsche Stiftung Organtransplantation, Region Nordrhein-Westfalen, Lindenallee 29-41, 45127 Essen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wirges
authors.affiliation: Deutsche Stiftung Organtransplantation, Deutschherrnufer 52, 60594 Frankfurt am Main, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.affiliation: Deutsche Stiftung Organtransplantation, Region Baden-Württemberg, Kriegerstraße 6, 70192 Stuttgart, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Schleicher