Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation

Abstract

Objective To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants. Method This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU). Results At retrieval, the frequency of donors with a creatinine clearance <60 mL/min, using the Cockcroft–Gault formula, and age >40 years were 31.7% and 32%, respectively. CIT > 24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE ( P = .0001), DGF ( P = .0001), CIT > 20 hours ( P = .005), nontraumatic the donor death ( P = .022), and donor ICUs bed capacity <20 ( P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6–13.4; P = .0001), 4.47 (95% CI, 2.6–7.6; P = .0001) and 1.7 (95% CI, 1–2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor– recipient gender pairings. Conclusion CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age >50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality.