Jma. Smits et al., Permanent detrimental effect of nonimmunological factors on long-term renal graft survival - A parsimonious model of time-dependency, TRANSPLANT, 70(2), 2000, pp. 317-323
Purpose. We attempted to model and test the pattern of effects of prognosti
c factors on renal graft survival during the posttransplantation time cours
e.
Patients and methods. Patients who received a cadaveric kidney-only transpl
ant between January 1990 and December 1995 in Eurotransplant,(7) who receiv
ed cyclosporine as induction therapy, and who had a complete follow-up at t
he time of analysis were included in the study (n=10614). An index summariz
ing all covariate information was calculated and used for modeling the time
-dependent effects with relation to graft failure.
Results. The immunological factors (HLA mismatch and % panel-reactive antib
ody) were seen to have a slowly decreasing negative effect on renal graft s
urvival. The cold ischemic trauma (>24 hr) exerted a permanent detrimental
effect on the grafts. The use of organs obtained from old donors was associ
ated with a constant higher risk of graft loss.
Conclusions. An analysis of determinants of human allograft dysfunction sho
uld also study the interaction between the effects and time. Nonimmunologic
al factors had a constant detrimental effect on graft failure, whereas the
impact of the immunological factors-although remaining important for late g
raft loss-very slowly decreased. In the context of marginal transplants, cl
ustering of unfavorable factors should be avoided to prevent late graft los
ses.