Nephrology Dialysis Transplantation, Vol 14, Issue 4 930-935, Copyright © 1999 by Oxford University Press
F Moreso, D Seron, S Gil-Vernet, L Riera, X Fulladosa, R Ramos, J Alsina and J Grinyo
Background. Transplant recipients of kidneys harvested
from old donors have a high incidence of delayed graft function (DGF) and a
poor graft outcome. This result is partly explained by the increased
incidence of acute rejection in patients suffering from DGF. However, the
long-term impact of donor age and DGF in rejection free renal transplants
is not well established. The aim of the present work is to evaluate the
impact of donor age and DGF on long-term outcome in renal transplant with
or without acute rejection. Patients. We review all
cadaveric kidney transplants performed in our centre between April 1984 and
December 1995 treated with a cyclosporin-based immunosuppression.
Results. Five hundred and ninety-five patients were
included. The overall incidence of DGF was 29.1%, and this event was
associated with an increased donor age and cold ischaemia time. Univariate
and multivariate analysis showed that graft loss was associated with acute
rejection (relative risk (RR) 2.24, 95% confidence interval (CI)
1.62-3.01); DGF (RR 1.83, 95% CI 1.32-2.54); donors >50 years (RR
1.65, 95% CI 1.13-2.38); and retransplantation (RR 1.52, 95% CI 1.01-2.31).
In rejection-free patients there were two independent predictors of graft
failure: donor >50 years (RR 2.40, 95% CI 1.45-4.01); and DGF (RR
2.42, 95% CI 1.53-3.84). Conclusions. Regardless of
the presence of acute rejection, delayed graft function amplifies the
detrimental effect of advanced donor age on long-term graft outcome.
Keywords: acute rejection; delayed function; donor
age; long-term graft outcome; renal transplant
ORIGINAL ARTICLES
Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients
Nephrology and Urology Departments, Ciutat Sanitàaria i Universitàia de Bellvitge, Barcelona, Spain; Corresponding author
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