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The importance of early renal graft function
V Martinek1, V Lanska, E Tschernoster
1Institute for Clinical and Experimental Medicine, Prague, Czechoslovakia.
Summary
Delayed graft function in kidney transplants is not always a poor prognostic sign. Most delayed function grafts recover well, showing similar long-term survival to early function grafts when non-functioning grafts are excluded.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Outcomes Research
Background:
- Kidney transplant outcomes are influenced by graft function onset.
- Understanding factors affecting early graft function is crucial for patient and graft survival.
Purpose of the Study:
- To analyze the impact of early, delayed, and non-functioning kidney allografts on patient and graft survival.
- To identify risk factors associated with delayed graft function and non-function.
Main Methods:
- Retrospective analysis of 7923 cadaveric kidney transplants.
- Multivariate analysis of 1743 cases to identify risk factors for delayed and non-functioning grafts.
- Comparison of 5-year survival rates based on graft function status.
Main Results:
- 42.3% of grafts had early function, 43.6% delayed function, and 14.1% never functioned.
- Risk factors for delayed function were non-immune (dialysis length, ischemia time); risk factors for non-function were immune (PRA, DR mismatches, no CsA, previous Tx).
- Five-year graft survival was similar for early and delayed function grafts (excluding non-functioning ones), but worse for non-functioning grafts. Recipient survival showed no difference between early and delayed function groups.
Conclusions:
- Delayed graft function is not inherently a poor prognostic indicator, as most grafts recover.
- The definition of 'early function' versus 'delayed function' requires careful consideration.
- Non-functioning grafts significantly worsen recipient survival, highlighting the importance of graft viability.