Impact of donor/recipient traits independent of rejection on long-term renal function

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.