FACTORS RELATED TO THE DONOR ORGAN ARE MAJOR DETERMINANTS OF RENAL-ALLOGRAFT FUNCTION AND SURVIVAL

In this study, we analyzed the relative impact of donor and recipient variables on cadaveric renal allograft function and survival. The uniq ue feature of the study population is that each pair of recipients rec eived their allografts from a single donor. The study includes 378 adu lt patients. In 129 pairs both recipients were Caucasian, and in 60 pa irs one recipient was Caucasian and the other was African American. Al l transplants were done in one center, thus minimizing differences in preservation time and providing uniform posttransplant management. The initial analysis showed a relationship between the function of the al lograft 6 months after transplantation (serum creatinine [SCr](6 mo)) and donor variables (P = 0.0004, analysis of variance). Furthermore, i t was calculated that 64% of the variability in the SCr6 mo among pati ents was due to donor factors and 36% was due to recipient factors. An elevated SCr6 mo was significantly associated with older donors, male recipients, and patients with acute rejection episodes. Furthermore, other unidentified donor factors may have an impact on allograft funct ion. Reflecting the importance of donor factors, there was a significa nt relationship between SCr6 mo in paired recipients (P < 0.0008 by Sp earman). Analysis of racially dissimilar pairs showed that the SCr6 mo and graft survival 6 months after transplantation were not significan tly different between Caucasians and African-Americans. However, beyon d 6 months, graft survival was worse in African-Americans (P < 0.0001 by Cox). Compared with Caucasians, graft survival was significantly wo rse in African-Americans with poorly controlled blood pressure (mean a rterial pressure > 105 mmHg) (P = 0.002, Cox), but not in those patien ts with mean arterial pressure < 105 mmHg. In conclusion, donor factor s are major determinants of renal allograft function. However, those f actors may not be easily identifiable or quantifiable. Donor factors d o not contribute to racial differences in allograft survival. However, poorly controlled hypertension correlates with poor renal graft survi val in African-Americans.