The outcome of delayed graft function in cadaveric renal transplants treated with low dose cyclosporine

Thirty-three consecutive cadaveric renal transplantations performed at the National Taiwan University Hospital from November 1985 to December 1989 were reviewed to determine the effect of early function on the 1-year patient and graft survival rates. Immediate function was present in 17 transplants; delayed graft function with acute tubular necrosis occurred in 16 cases. The 16 transplants with acute tubular necrosis (ATN) were treated with low dose cyclosporine. Among them, 13 patients had delayed function which resolved after 2 to 60 days of hemodialysis, but 3 grafts did not regain function. The allograft survival rate at 1-year was 68.7% for the delayed function group and 88.2% for the immediate function group. This difference was not statistically significant (p greater than 0.05). The 1-year patient survival rate was also not significantly different (87.5% vs 88.2%). There was no relationship between graft loss and duration of ATN. However, the graft survival rate in patients with a serum creatinine level below 2 mg/dL, after recovery either from ATN or non-ATN, was better than that for patients with a serum creatinine level of more than 2 mg/dL. The difference was statistically significant (95.8% vs 50.0%, p less than 0.02). It is concluded that delayed allograft function with acute tubular necrosis does not significantly alter the 1-year survival rates of patients and grafts in low-dose cyclosporine therapy. However, it is deleterious to the 1-year survival rate of an allograft when poor functional recovery occurs in an ATN or non-ATN condition.