Early graft function and patient survival following cadaveric renal transplantation

Background. The influence of events that occur early following renal transp lantation such as delayed graft function (DGF) and acute rejection on long- term graft survival has been widely reported, but its association with pati ent survival has received less attention. Methods. We studied 589 patients who received their first cadaveric transpl ants between 1984 and 1993, all of whom received cyclosporine-based immunos uppression and who had a median follow-up of seven years. The following fac tors were identified, and both univariate and multivariate analyses were us ed to determine their association with long-term patient and graft survival : age, sex, duration of pretransplant dialysis, primary renal disease, imme diate graft function (IGF), DGF, primary nonfunction (PNF), acute rejection , and serum creatinine at 3, 6, and 12 months. Results. Patients with PNF had a poorer survival than those with DGF and IG F (P = 0.01), but there was no difference in survival between DGF and IGF ( P = 0.54). Good graft function (serum creatinine of less than 200 mu mol/li ter) at three months was predictive of better long-term patient survival (P = 0.03). Other factors associated with poor patient outcome were older age , diabetes, adult polycystic kidney disease, male gender, and acute rejecti on. Cardiovascular disease was the most common cause of death (51.8%). Good graft function at three months (P < 0.001) and an absence of rejection epi sodes (P = 0.01) were associated with better graft survival. Conclusion. Patients with poor levels of early graft function (but not DGF) and those with either acute rejection episodes or early graft loss are at an increased risk of early death. These high-risk groups should be targeted for interventional studies in an attempt to improve patient survival.