DELAYED GRAFT FUNCTION, ACUTE REJECTION, AND OUTCOME AFTER CADAVER RENAL TRANSPLANTATION

作者：Christoph Troppmann, Kristen J. Gillingham, Enrico Benedetti, Patrick Stephen Almond, Rainer W.G. Gruessner, John S. Najarian, Arthur J. Matas · 发表于：Transplantation · 年份：1995 · DOI：10.1097/00007890-199504150-00007 · 被引用次数：519 · 研究领域：Renal Transplantation Outcomes and Treatments、Organ Donation and Transplantation、Renal and Vascular Pathologies

The impact of delayed graft function on outcome after cadaver renal transplantation has been controversial, but most authors fail to control their analyses for the presence or absence of rejection. We studied 457 adult recipients of primary cadaver allografts at a single institution during the cyclosporine era. All patients received sequential immunosuppression. The incidence of delayed graft function (defined as dialysis being required during the first week after transplant) was 23%. There was a significant association between delayed graft function and cold ischemia time > 24 hr (P = 0.0001) and between delayed graft function and the occurrence of at least one biopsy-proven rejection episode (P = 0.004). Actuarial graft survival was not significantly different when comparing delayed graft function versus no delayed graft function for patients without rejection (P = 0.02). However, it was significantly worse for patients with both delayed graft function and rejection versus those with delayed graft function but no rejection (P = 0.005), as well as for grafts preserved > 24 hr versus < or = 24 hr (P = 0.007). By multivariate analysis, delayed graft function per se was not a significant risk factor for decreased graft survival for patients without rejection (P = 0.42). In contrast, rejection significantly decreased graft survival for grafts with immediate function (relative risk = 2.3, P = 0.0002), particularly in combination with delayed graft function (relative risk = 4.2, P...