Survival of sub-optimal cadaver renal grafts with prolonged cold ischaemic times using cyclosporin

Between September 1983 and December 1985, 33 cadaver kidneys with prolonged ischaemic times (mean 47.3 +/- 11.0 h), and frequently in problematic conditions, were received from Europe and transplanted into adults (16 male, 12 female, mean age 34 +/- 11 years) and children (2 male, 3 female, mean age 8.8 +/- 4.0 years), using cyclosporin (CsA) and steroid immunosuppression. Six patients have died (three with functioning grafts) and 12 grafts have been lost. Eighteen grafts remain functioning, with a mean survival of 27 months. The 1 year actuarial patient and graft survivals were 82% and 69% respectively. The mean time to cessation of haemodialysis was 17 +/- 10 days, and to stable graft function was 28 +/- 11 days. At 3 months (27 patients) mean serum creatinine was 191 +/- 88 mumol/l (2.16 +/- 1.0 mg/dl), with a mean CsA dose of 6.7 +/- 2.2 mg/kg per day. There was an association between the immediate post-transplant renographic perfusion index and the serum creatinine at 3 months (r = 0.52, P less than 0.01). At no stage did the serum creatinine correlate with CsA dose or length of ischaemic time. These results demonstrate that despite suboptimal conditions, prolonged cold ischaemic times, and periods of oliguria, cadaver kidney transplants may be managed successfully with CsA and low-dose steroids.