THE RELATIVE INFLUENCE OF DELAYED GRAFT FUNCTION AND ACUTE REJECTION ON RENAL-TRANSPLANT SURVIVAL

Three hundred and eight cadaveric renal transplants were analysed to e stablish the effects of acute rejection in the first 90 days and delay ed graft function (DGF) on graft outcome. There were 120 patients (39% ) with no DGF and no rejection (group 1), 101 patients (33%) with reje ction but no DGF (group 2), 41 patients (13%) with DGF but no rejectio n (group 3) and 46 patients (15%) with both rejection and DGF (group 4 ). The actuarial 4-year graft survival rates for groups 1,2,3 and 4 we re 78.3%, 65.4%, 60.1% and 40.4%, respectively. The acute rejection ra te was 101/221 (46%) in patients with initial graft function compared with 46/87 (53%) for those with DGF (chi(2) = 1.02, P = 0.31). Cox ste pwise logistic regression analysis demonstrated that DGF was a more po werful predictive factor for poor graft survival (P = 0.001) than acut e rejection occurring in the first 90 days post-transplant (P = 0.034) . Further efforts at improving graft outcome should concentrate on red ucing the incidence of DGF.