ANALYSIS OF CAUSES OF GRAFT FAILURE AFTER CADAVERIC KIDNEY TRANSPLANTATION COMPARED TO LIVING UNRELATED DONOR KIDNEY TRANSPLANTATION

Abstract

169 Graft survival of living unrelated (LURD) kidney transplants (KTXs) is superior to that of cadaver (Cad) KTXs despite poor HLA compatibility. Analyzing UNOS data, Terasaki et al attributed the high rate of survival to the fact that the kidneys from LURDs were uniformly healthy. In this study, the authors did not analyze the causes of graft failure. The purpose of the present study is to perform a detailed analysis of the causes of graft failure in Cad KTXs compared to LURD KTXs in an attempt to gain insight into why Cad KTXs do poorly compared to LURD KTXs. Methods: Kidney transplants (894 LURD TXs and 50,796 Cad TXs) with a minimum follow-up of 3 years were analyzed using UNOS database. Demographic characteristics, HLA match, and ischemia times for the two groups are shown in the following Table.(Table 1)Table 1Results: Actuarial 3-year graft survival rates for LURD TXs and Cad TXs were 73% and 67%, respectively (death censored survival rates 81% and 75%, respectively). The causes of graft failure which are significantly different between the two groups are shown in the following Table.(Table 2)Table 2The incidence of graft failure from causes other than mentioned above (including hyperacute rejection, acute rejection, graft thrombosis, infection, surgical and urologic complications, recurrent disease, non-compliance, death of patient, and unknown) is not significantly different between the two groups. Conclusions: Graft survival of Cad KTXs is inferior to that of LURD TXs due to increased graft loss from primary failure, chronic rejection and "other cause". These reasons may reflect differences in organ quality at the time of transplant and suggest the magnitude of potential benefit to be gained by improving the cadaver donor organ quality.