THE IMPORTANCE OF EARLY RENAL GRAFT FUNCTION

Onset of function and consequent graft and patient survival in 7923 ca daveric kidney transplants (Tx) were analysed; 42.3% of grafts had ear ly function, 43.6% delayed function, defined as a temporary need of di alysis postoperatively, and 14.1% grafts never functioned. Multivariat e analysis of 1743 cases showed that important risk factors for delaye d function were of non-immune origin, i.e. length of pre-Tx dialysis, or warm and cold ischaemia. The significant risk factors for non-funct ioning were of immune origin i.e. panel-reactive antibodies, DR mismat ches, immunosuppression without cyclosporin A and previous Tx. Five-ye ar survival rates of early function and delayed function grafts were i dentical when non-functioning grafts were excluded. Comparison of earl y function with delayed function grafts divided according to the lengt h of the function delay showed worse (P < 0.05) survival in grafts wit h delayed function > 20 days only (50.6% grafts had delayed function < 10 days, 32.7% 10-20 days, and 16.7% > 20 days). Survival of recipien ts with non-functioning grafts was worse (P < 0.01) than those with ea rly function and delayed function grafts. There was no difference in r ecipients' survival between early function and delayed function groups . When comparing early function and delayed function graft outcome, th e problem is not so much a question of how as when to define early fun ction. A statement that delayed function is prognostically a bad sign is not correct, as most delayed function grafts recover spontaneously without any effect on long-term graft and patient survival. The poorer survival of grafts with delayed function > 20 days and the risk of no n-functioning stresses the need to take precautionary measures to ensu re early function. Kidneys with risk factors for delayed function shou ld not be used in the presence of immune factors associated with non-f unction.