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December 4, 1996, Vol 276, No. 21 >
ARTICLE | December 4, 1996

Antigen-Independent Determinants of Cadaveric Kidney Transplant Failure FREE

Glenn M. Chertow, MD, MPH; Edgar L. Milford, MD; Harald S. Mackenzie, MB, ChB; Barry M. Brenner, MD
[+] Author Affiliations

Reprints: Glenn M. Chertow, MD, MPH, Dialysis Unit Administrative Office, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (e-mail: gmchertow @bics.bwh.harvard.edu).


JAMA. 1996;276(21):1732-1736. doi:10.1001/jama.1996.03540210040031
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References

Objective.  —To determine the association of various antigen-independent factors with long-term cadaveric kidney transplant failure.

Design.  —Cohort analytic study.

Setting.  —Kidney transplant centers (N=131) in the United States.

Patients.  —A total of 31 515 patients who received cadaveric kidney transplants between October 1987 and December 1991. Patients with unknown or uninterpretable vital status or graft survival time (n=264 [0.8%]) were excluded.

Main Outcome Measure.  —Graft failure, estimated at 2 extremes, depending on whether the death of a patient with a functioning graft was censored ("censored graft failure") or not ("uncensored graft failure").

Results.  —During the 62-month study period, 5883 patients required the reinstitution of dialysis because of graft failure, 2404 patients died with graft failure, and 2041 patients died with a functioning graft. The relative risks of censored and uncensored graft failure were significantly associated with donor age, sex, and race and recipient body surface area, after adjusting for recipient age, sex, race, diabetes, cold ischemia time, panel cross-reactivity, pretransplant blood transfusions, previous renal transplantation, functional status, and HLA antigen mismatch.

Conclusions.  —In cadaveric kidney transplantation, selected demographic and anthropometric factors are significantly related to long-term graft outcomes, even after adjusting for well-known antigen-dependent risk factors. These results support the hypothesis that the supply of viable donor nephrons and the physiologic demands of the transplant recipient are important determinants of long-term graft failure. Antigen-independent factors such as donor age should be incorporated into organ allocation algorithms to optimize equity and efficiency.

REFERENCES

1 +
Opelz G, Schwarz V, Engelmann A, Back D, Wilk M, Keppel E.  Long-term impact of HLA matching on kidney graft survival in cyclosporine-treated patients . Transplant Proc . 1991;;23:373-375.
2 +
Rennke HG.  Patholgy of glomerular hyperfiltration . In: Mitch WE, Brenner BM, Stein JH, eds. The Progressive Nature of Renal Disease: Contemporary Issues in Nephrology . New York, NY: Churchill-Livingstone; 1986;:111-113.
3 +
Heemann UW, Tullius SG, Azuma H, Mackenzie HS, Brenner BM, Tilney NL.  Evidence for a beneficial effect of increased functional kidney mass upon chronic kidney rejection in rats . Transplant Proc . 1994;;26:2047-2051.
4 +
Heemann UW, Azuma H, Tullius SG, et al.  Influence of renal mass on chronic kidney allograft rejection in rats . Transplant Proc . 1995;;27:549.
5 +
1994 Report of Center-Specific Graft and Patient Survival Rates. Richmond, Va: UNOS; Bethesda, Md: Division of Organ Transplantation, Bureau of Health Research Development, Health Resources and Services Administration, US Dept of Health and Human Services; 1994.
6 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
7 +
Mantel N.  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;;50:163-170.
8 +
Cox DR.  Regression models and life tables . J R Stat Soc [B] . 1972;;74:187-220.
9 +
Collett D. Modelling Survival Data in Medical Research . London, England: Chapman & Hall; 1994;.
10 +
Therneau TM, Grambsch PM, Fleming TR.  Martingale-based residuals for survival models . Biometrika . 1990;;77:147-160.
11 +
SAS Institute, Inc. SAS/STAT User's Guide, Version 6. 4th ed. Cary, NC: SAS Institute; 1990.
12 +
Kaplan C, Pasternak B, Shah H, Gallo G.  Agerelated incidence of sclerotic glomeruli in human kidneys . Am J Pathol . 1975;;80:227-234.
13 +
Kappel B, Olsen S.  Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex: a quantitative study . Virchows Arch . 1980;;387:271-277.
14 +
Nyengaard JR, Bendtsen TF.  Glomerular number and size in relation to age, kidney weight, and body surface in normal man . Anat Rec . 1992;;232:194-201.
15 +
Walter F, Addis T.  Organ work and organ weight . J Exp Med . 1939;;69:467-483.
16 +
Brenner BM, Garcia DL, Anderson S.  Glomeruli and blood pressure: less of one, more the other? Am J Hypertens . 1988;;1:335-347.
17 +
Tauchi H, Tsuboi K, Okutomi J.  Age changes in the human kidney of different races . Gerontologia . 1971;;17:87-97.
18 +
MacKay EM.  Kidney weight, body size, and renal function . Arch Intern Med . 1932;;50:590-594.
19 +
Brenner BM, Cohen RA, Milford EL.  In renal transplantation, one size may not fit all . J Am Soc Nephrol . 1992;;3:162-169.
20 +
Terasaki PI, Koyama H, Cecka JM, Gjertson DW.  The hyperfiltration hypothesis in human renal transplantation . Transplantation . 1994;;57:1450-1454.
21 +
Kupin WL, Venkat KK, Mozes M.  Predictive value of the donor surface area/recipient surface area ratio on the outcomes of primary cadaveric renal transplantation . J Am Soc Nephrol . 1993;;4:945. Abstract.
22 +
Kupin W, Venkat KK, Goggins M, Mozes M, Escobar F.  Mismatch of donor/recipient size and the development of renal transplant glomerulopathy . J Am Soc Nephrol . 1994;;5:1019. Abstract.
23 +
Roth D, Olson L, Esquenazi V, Miller J.  Donor renal mass in renal transplantation: how much kidney is sufficient? J Am Soc Nephrol . 1994;;5:1035. Abstract.
24 +
Gaston RS, Hudson SL, Julian BA, et al.  Impact of donor/recipient size matching on outcomes in renal transplantation . Transplantation . 1996;;61:383-388.
25 +
Butkus DE, Meydrech EF, Raju SS.  Racial differences in the survival of cadaveric renal allografts . N Engl J Med . 1992;;327:840-845.
26 +
Cecka JM, Terasaki PI.  The UNOS Scientific Renal Transplant Registry . In: Terasaki PI, Cecka JM, eds. Clinical Transplants 1994 . Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1994;:1-18.
27 +
Tesi RJ, Elkhammas EA, Davies EA, Henry ML, Ferguson RM.  Renal transplantation in older people . Lancet . 1994;;343:461-464.
28 +
Howard RJ, Pfaff WW, Scornik JC, Salomon DR, Peterson JC, Brunson ME.  Kidney transplantation in older patients . Clin Transplant . 1990;;4:181-186.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Opelz G, Schwarz V, Engelmann A, Back D, Wilk M, Keppel E.  Long-term impact of HLA matching on kidney graft survival in cyclosporine-treated patients . Transplant Proc . 1991;;23:373-375.
2 +
Rennke HG.  Patholgy of glomerular hyperfiltration . In: Mitch WE, Brenner BM, Stein JH, eds. The Progressive Nature of Renal Disease: Contemporary Issues in Nephrology . New York, NY: Churchill-Livingstone; 1986;:111-113.
3 +
Heemann UW, Tullius SG, Azuma H, Mackenzie HS, Brenner BM, Tilney NL.  Evidence for a beneficial effect of increased functional kidney mass upon chronic kidney rejection in rats . Transplant Proc . 1994;;26:2047-2051.
4 +
Heemann UW, Azuma H, Tullius SG, et al.  Influence of renal mass on chronic kidney allograft rejection in rats . Transplant Proc . 1995;;27:549.
5 +
1994 Report of Center-Specific Graft and Patient Survival Rates. Richmond, Va: UNOS; Bethesda, Md: Division of Organ Transplantation, Bureau of Health Research Development, Health Resources and Services Administration, US Dept of Health and Human Services; 1994.
6 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
7 +
Mantel N.  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;;50:163-170.
8 +
Cox DR.  Regression models and life tables . J R Stat Soc [B] . 1972;;74:187-220.
9 +
Collett D. Modelling Survival Data in Medical Research . London, England: Chapman & Hall; 1994;.
10 +
Therneau TM, Grambsch PM, Fleming TR.  Martingale-based residuals for survival models . Biometrika . 1990;;77:147-160.
11 +
SAS Institute, Inc. SAS/STAT User's Guide, Version 6. 4th ed. Cary, NC: SAS Institute; 1990.
12 +
Kaplan C, Pasternak B, Shah H, Gallo G.  Agerelated incidence of sclerotic glomeruli in human kidneys . Am J Pathol . 1975;;80:227-234.
13 +
Kappel B, Olsen S.  Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex: a quantitative study . Virchows Arch . 1980;;387:271-277.
14 +
Nyengaard JR, Bendtsen TF.  Glomerular number and size in relation to age, kidney weight, and body surface in normal man . Anat Rec . 1992;;232:194-201.
15 +
Walter F, Addis T.  Organ work and organ weight . J Exp Med . 1939;;69:467-483.
16 +
Brenner BM, Garcia DL, Anderson S.  Glomeruli and blood pressure: less of one, more the other? Am J Hypertens . 1988;;1:335-347.
17 +
Tauchi H, Tsuboi K, Okutomi J.  Age changes in the human kidney of different races . Gerontologia . 1971;;17:87-97.
18 +
MacKay EM.  Kidney weight, body size, and renal function . Arch Intern Med . 1932;;50:590-594.
19 +
Brenner BM, Cohen RA, Milford EL.  In renal transplantation, one size may not fit all . J Am Soc Nephrol . 1992;;3:162-169.
20 +
Terasaki PI, Koyama H, Cecka JM, Gjertson DW.  The hyperfiltration hypothesis in human renal transplantation . Transplantation . 1994;;57:1450-1454.
21 +
Kupin WL, Venkat KK, Mozes M.  Predictive value of the donor surface area/recipient surface area ratio on the outcomes of primary cadaveric renal transplantation . J Am Soc Nephrol . 1993;;4:945. Abstract.
22 +
Kupin W, Venkat KK, Goggins M, Mozes M, Escobar F.  Mismatch of donor/recipient size and the development of renal transplant glomerulopathy . J Am Soc Nephrol . 1994;;5:1019. Abstract.
23 +
Roth D, Olson L, Esquenazi V, Miller J.  Donor renal mass in renal transplantation: how much kidney is sufficient? J Am Soc Nephrol . 1994;;5:1035. Abstract.
24 +
Gaston RS, Hudson SL, Julian BA, et al.  Impact of donor/recipient size matching on outcomes in renal transplantation . Transplantation . 1996;;61:383-388.
25 +
Butkus DE, Meydrech EF, Raju SS.  Racial differences in the survival of cadaveric renal allografts . N Engl J Med . 1992;;327:840-845.
26 +
Cecka JM, Terasaki PI.  The UNOS Scientific Renal Transplant Registry . In: Terasaki PI, Cecka JM, eds. Clinical Transplants 1994 . Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1994;:1-18.
27 +
Tesi RJ, Elkhammas EA, Davies EA, Henry ML, Ferguson RM.  Renal transplantation in older people . Lancet . 1994;;343:461-464.
28 +
Howard RJ, Pfaff WW, Scornik JC, Salomon DR, Peterson JC, Brunson ME.  Kidney transplantation in older patients . Clin Transplant . 1990;;4:181-186.

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