Early graft function and patient survival following cadaveric renal transplantation

• Published in: Kidney international Vol. 55; no. 2; pp. 692 - 699
• Main Authors: Woo, Y. Mun, Jardine, Alan G., Clark, Alan F., Macgregor, Mark S., Bowman, Adrian W., Macpherson, Stuart G., Briggs, J. Douglas, Junor, Brian J.R., Mcmillan, Margaret A., Rodger, R. Stuart C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-1999; Nature Publishing
• Subjects: acute rejection; Adolescent; Adult; Aged; allograft function; Biological and medical sciences; cardiovascular death; delayed graft function; Female; Graft Rejection - mortality; Graft Survival - physiology; Humans; Kidney - physiopathology; Kidney Transplantation; Male; Medical sciences; Middle Aged; primary non-function; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Analysis; Time Factors; transplant survival; cardiovascular death; acute rejection; transplant survival; primary non-function; delayed graft function; allograft function; Kidney disease; Urinary system disease; Renal function; Mortality; Homograft; Transplantation; Epidemiology; Kidney; Rejection; Concomitant disease; Surgery; Risk factor; Complication
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.1999.00294.x

Early graft function and patient survival following cadaveric renal transplantation.
The influence of events that occur early following renal transplantation such as delayed graft function (DGF) and acute rejection on long-term graft survival has been widely reported, but its association with patient survival has received less attention.
We studied 589 patients who received their first cadaveric transplants between 1984 and 1993, all of whom received cyclosporine-based immunosuppression and who had a median follow-up of seven years. The following factors were identified, and both univariate and multivariate analyses were used to determine their association with long-term patient and graft survival: age, sex, duration of pretransplant dialysis, primary renal disease, immediate graft function (IGF), DGF, primary nonfunction (PNF), acute rejection, and serum creatinine at 3, 6, and 12months.
Patients with PNF had a poorer survival than those with DGF and IGF (P = 0.01), but there was no difference in survival between DGF and IGF (P = 0.54). Good graft function (serum creatinine of less than 200 μmol/liter) at three months was predictive of better long-term patient survival (P = 0.03). Other factors associated with poor patient outcome were older age, diabetes, adult polycystic kidney disease, male gender, and acute rejection. Cardiovascular disease was the most common cause of death (51.8%). Good graft function at three months (P < 0.001) and an absence of rejection episodes (P = 0.01) were associated with better graft survival.
Patients with poor levels of early graft function (but not DGF) and those with either acute rejection episodes or early graft loss are at an increased risk of early death. These high-risk groups should be targeted for interventional studies in an attempt to improve patient survival.