DETERMINANTS OF GRAFT-SURVIVAL AFTER RENAL-TRANSPLANTATION

We studied multiple determinants of graft survival at a single center and the effects of nonimmunologic graft loss on transplant survival, T his retrospective study examined the results of 589 cadaver donor tran splants performed between 1986 and 1992, Graft survival rates were cal culated using Kaplan-Meier estimates for both overall graft survival ( all causes of graft loss) and immunologic graft survival (function los t due to acute or chronic rejection and noncompliance), Cadaver graft survival was significantly poorer with an increasing degree of DR mism atch (P=0.02), An analysis of pretransplant variables showed graft los s risk was highest with greater DR mismatches, two B-antigen mismatch, higher donor serum creatinine, and younger recipient age, After trans plantation, acute rejection was the most significant factor associated with long-term graft survival, Our data demonstrate a significant adv antage for zero DR and one DR mismatch cadaver donor transplants, with excellent immunologic graft survival, This study suggests that a comb ination of immediate graft function, prevention of acute rejection by appropriate early immunosuppressive therapy, and acceptable DR match e nhances cadaveric graft survival.