THE IMPACT OF THE QUALITY OF INITIAL GRAFT FUNCTION ON CADAVER KIDNEY-TRANSPLANTS

Living unrelated donor (LURD) transplants have immunologic barriers si milar to cadaver transplants, yet the outcome is better (1-year graft survival = 96%). One advantage of LURD transplants is that, with the e xtremely short preservation time, the kidney functions immediately. We studied whether the quality of initial renal function affects the out come of primary cadaver transplants. We divided 301 non-6-antigen-matc hed recipients transplanted between 1/1/86 and 8/1/92-who had no graft loss due to hyperacute rejection, primary nonfunction, or technical r easons-into 5 groups based on the quality of initial renal function (s erum creatinine level in the first week). We determined patient and gr aft survival rates for each group. We found that the quality of initia l function had a significant effect on patient and graft survival rate s. Recipients whose serum creatinine level was <3 mg/dl on posttranspl ant day 5 (groups 1 and 2) had better patient and graft survival than either those whose serum creatinine level was >3 mg/dl on day 7 (group 4) or those who required dialysis (group 5). Because some early dysfu nction may be immunologic, we reanalyzed the data excluding patients w ith percent reactive antibody greater-than-or-equal-to 15; the quality of initial function in this group had a significant impact on outcome . Similarly, when patients with graft loss due to ''death with functio n'' were excluded, the quality of initial function had a significant i mpact on survival rates. We conclude that the quality of early posttra nsplant function is an important predictor of long-term outcome. Cadav er recipients with immediate good function have outcomes similar to li ving donor recipients. Our data suggest that increased effort should b e made to improve immediate posttransplant function.