Impact of immunologic and nonimmunologic variables on long-term outcome after kidney transplantation

To assess the effect of longer cold ischemia time and other parameters on outcomes after kidney transplantation, where both organs were taken from the same donor and transplanted in the same clinic.

Retrospective analysis of renal transplants at our center.

From December 1990 to June 2006, we identified 166 transplant patients who received one organ from a pair. Median donor age was 52.4 years, median follow-up of recipients was 56 months (range = 0-156). Cold ischemia time of the group who underwent first transplantation (receiving the first kidney of a pair from one donor, designated group 1) was 644 minutes; for the second transplantation (group 2), 917 minutes (P < .0001). No difference was observed in warm ischemia times (40.8 +/- 12.9 vs 42.5 +/- 12.7 minutes, P = .4) or number of mismatches (MM; 3.4 vs 3.5, P = .7). The 5-year graft survival of the whole group was 66% with a death-censored value of 75%. Group 1 patients tended to show better primary graft function rates (80% vs 72%; P = .1). No significant differences were observed in 1-year graft survival rates for the two groups (81% vs 78%, P = .7) or in long-term graft survival (log-rank: P = .7). There was no influence of the number of MM on delayed graft function rates, but it was significant for long-term graft survival (log-rank: P [uncensored for death] = .023 for 0-3 MM vs 4-6 MM).

Nonimmunologic parameters have less influence on the outcome of kidney transplantation than immunologic factors.