Immunologic and nonimmunologic factors - Different risks for cadaver and living donor transplantation

Background There is a debate about the relative contribution of immunologic (rejection) and nonimmunologic (limited nephron mass) factors in long-term graft survival, Methods, Using multivariate analysis, we studied the association of the fol lowing variables with outcome: delayed graft function (DGF), acute rejectio n, recipient race (black vs, nonblack), donor age (<50 vs. greater than or equal to 50), donor race, and donor and recipient gender. Because of the as sociation between DGF and rejection, recipients were grouped as follows: DG F, rejection; DGF, no rejection; no DGF, rejection; no DGF, no rejection, D ata were analyzed on 1199 first kidney transplants in adults (752 living do nor, 447 cadaver donor) done between January 1, 1985 and December 31, 1996, Two analyses were done: first, all transplants; second, only those with gr eater than or equal to 1 year survival. For both, there was no difference i n risk factors if death with function was or was not censored. Results. For all cadaver transplant recipients, risk factors were acute rej ection, DGF plus rejection, black recipient race, and donor age greater tha n or equal to 50, For living donor recipients, only acute rejection was a r isk factor. When only 1-year graft survivors were considered, risk factors were the same: for cadaver recipients, risk factors were acute rejection, D GF plus rejection, black recipient race, and donor age greater than or equa l to 50; for living donor recipients the risk factor was rejection. Conclusion. We found immunologic factors (rejection with or without DGF) to be significant in both living donor and cadaver donor transplants, Nonimmu nologic factors (donor age, recipient race) were significant only in cadave r donor transplants.