Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection

We studied the effect of initial graft function and acute rejection on graf t survival in 1047 cadaveric renal transplantations during 1991-1997 with a constant policy of donor selection, graft allocation, and immunosuppressio n. The overall 1- and 5-year patient survival rates were 96% and 88%, and t he 1- and 5-year graft survival (GS) rates were 92% and 78%. Delayed graft function (DGF) occurred in 31% and there were 1.2% never-functioning grafts . One-year GS in transplantations with early graft function (EGF) was 95% c ompared to 87% in DGF (P < 0.001). Donor age and cause of death, type of gr aft perfusion and cold ischemia time. and type and length of dialysis treat ment were significant factors in determining the onset of graft function. T hese factors did not have a significant direct effect on GS. Early ( < 100 days) acute rejection occurred in 25%. In transplantations without rejectio n, the 1 and 5-year GS was 93.3% and 80.8%. In acute rejection responding t o steroids, the GS was equal to that up to 3 years, but after that a signif icantly worse survival rate was observed (1- and 5-year GS: 93.6% and 73.4z %). DGF was detrimental to GS both in transplantations without rejection an d in all rejection types.