This study describes renal function at multiple points in time after transp
lantation and the influence of donor and recipient factors independent of r
ejection on this function. Donor and recipient records for 83 consecutive c
adaveric renal transplants performed between 1992 and 1994 at Johns Hopkins
Bayview Medical Center were reviewed retrospectively. Donor age, gender, w
eight, terminal serum creatinine (Cr), intensive care unit days, blood pres
sure, presence of cardiac arrest, kidney only versus multiple organ donatio
n, and cold ischemia time and recipient age, gender, weight, pretransplant
pregnancy status, and rejection episodes were recorded. The influences of e
ach of these parameters on changes in recipient Cr clearance over time (der
ived using the Cockcroft-Gault formula from recipient serum Cr at 3 months
and annually up to 5 years) were analyzed first individually, then together
in an analysis with multiple explanatory variables. Parameters indicative
of donor ischemia tie, donor blood pressure, presser administration, and oc
currence of cardiac arrest) were not predictive of the course of recipient
Cr clearance. With the inclusion of rejection, this analysis shows the magn
itude of the independent effects that donor age, donor Cr clearance, and re
cipient gender have on the subsequent time course of recipient Cr clearance
(P < 0.05). Recipient gender and the presence of rejection appear to have
a fixed effect on the level of Cr clearance, whereas donor age and donor Cr
clearance appear to influence the level and the time course of recipient C
r clearance. Of all these factors, donor age appears to have the greatest i
mpact on recipient Cr clearance at all times. Analyzing renal function in t
his way may prove to be a more sensitive indicator than actuarial survival
analysis for evaluating the early effects of changes in transplantation pro
tocols and pharmacologic interventions. (C) 2001 by the National Kidney Fou
ndation, Inc.