A comparison of the survival of shipped and locally transplanted cadavericrenal allografts.

Background: The effect on allograft survival of the shipment of cadaveric r enal allografts from one organ-procurement organization to another is uncer tain. Methods: Using data from the Organ Procurement and Transplantation Network of the United Network for Organ Sharing, we identified 5446 pairs of cadave ric kidneys (10,892 allografts) in which one kidney was shipped and the oth er was transplanted locally. We compared the risk of graft failure using st atistical models that accounted for confounding variables, including the de gree of HLA mismatching. Results: After adjustment for the degree of HLA mismatching, shipped organs had a significantly higher rate of allograft failure than locally transpla nted organs in the first year after transplantation (adjusted hazard ratio, 1.17; 95 percent confidence interval, 1.05 to 1.31; P=0.004), but not ther eafter. An association between the shipment of organs with no HLA mismatche s and allograft failure was not confirmed. Conclusions: The shipment of cadaveric renal allografts increases the risk of failure of HLA-mismatched grafts during the first year after transplanta tion.