PREDICTORS OF LONG-TERM PRIMARY CADAVERIC RENAL-TRANSPLANT SURVIVAL

The factors which predict long-term kindey allograft survival have bee n difficult to determine due to the reliance on multi-center data. A r etrospective review of the post-transplant course of 665 consecutive p rimary cadaveric (CAD) kidney transplants performed at a single center over an 8-year period was performed in an attempt to identify what de mographic, immunologic and post-transplant factors are important in pr edicting long-term kidney graft function. All recipients were treated with a uniform management strategy including sequential quadruple immu nosuppression and histologic confirmation of all episodes of graft dys function. The average length of follow-up was 56 months and no patient had less than 12 months of follow-up. Actuarial 8-year (yr) patient a nd graft survival was 76% and 57% respectively. Exclusion of 64 patien ts who died with a functioning graft from non-transplant related cause resulted in an improvement of 8-yr graft survival to 71%. Evaluation of factors predicting long-term graft survival with Cox analysis demon strated that the presence of ONE or greater than ONE (> ONE) rejection episode (relative risk [RR] = 6.45), diabetes mellitus (RR = 1. 72), and black race (RR = 1.31) were independent risk factors for graft los s. Censored graft survival for patients with NONE, ONE, or > ONE rejec tion episodes was 83%, 69% and 45% respectively. Rejection episodes oc curred in 47% of recipients. Two-third of rejection episodes occurred before 60 days and acute rejection episodes were rare after 1 yr. No i mmunologic factors including sex, current or maximum PRA, HLA mismatch , race or presence of diabetes mellitus predicted the risk of developi ng ONE or > ONE rejection episodes. These data suggest that patients w ihout an episode of acute rejection have excellent long-term graft sur vival regardless of demographic or immunologic risk-factors pre-transp lant. The presence of ONE or > ONE rejection episode is the most impor tant determinant of long-term renal allograft survival. Attempts to pr event rejection episodes should focus on better immunosuppression, and not on better matching, in recipients of first CAD kidney transplants .