Important Risk Factors of Allograft Survival in Cadaveric Renal Transplantation A Study of 426 Patients

Authors:
  • EBEugene H. Blackstone
    Eugene H. Blackstone
  • DNDavid C. Naftel
    David C. Naftel
  • SHSharon L. Hudson
    Sharon L. Hudson
  • WBWilliam H. Barber
    William H. Barber
  • MDMark H. Deierhoi
    Mark H. Deierhoi
  • BBBruce O. Barger
    Bruce O. Barger
  • JCJohn J. Curtis
    John J. Curtis
  • RLRobert G. Luke
    Robert G. Luke
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Abstract
Multiple risk factors contribute to the allograft survival of patients who have cadaveric renal transplantation. A retrospective review of 19 such factors in 426 patients identified race, DR match, B + DR match, number of transplants, and preservation time to have a significant influence. The parametric analysis confirmed the effect to be primarily in the early phase, i.e., first 6 months. All patients received cyclosporine with other methods of immunosuppression resulting in an overall 1-year graft survival rate of 66%. The overall 1-year graft survival rate in the white race was 73% and in the black race was 57% (p = 0.002). Allograft survival and DR match showed white recipients with a 1 DR match to have 75% survival at 1 year compared with 57% in the black patient (p = 0.009). If HLA B + DR match was considered, the white recipient allograft survival increased to 76%, 84%, and 88% for 1, 2, and 3 match kidneys by parametric analysis. Patients receiving first grafts had better graft survival (68%) than those undergoing retransplantation (58%) (p = 0.05). Organ preservation less than 12 hours influenced allograft survival with a 78% 1-year survival rate compared with 63% for kidneys with 12-18 hours of preservation. Despite the benefits of B + DR typing, short preservation time, and first transplants to the white recipient, the allograft survival in the black recipient remained uninfluenced by these parameters.

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