PERMANENT DETRIMENTAL EFFECT OF NON-IMMUNOLOGICAL FACTORS ON LONG-TERM GRAFT SURVIVAL. A PARSIMONIOUS MODEL OF TIME-DEPENDENCY.:

92 Purpose: To determine a possible time-dependent association of various prognostic factors with long-term cadaveric renal graft survival. Patients and Methods: Patients who received a cadaveric kidney only transplant between Jan. 1990 and Dec. 1995 in our registry, who received cyclosporine in their induction therapy and who had a follow up of a least 3 years (N=10614). An index summarizing all information was calculated and used for multivariate modeling of time-dependent effects. Results: The relative risks of graft loss for the different factors at different post-transplant episodes are depicted in the table. The immunological factors had a slowly but statistically significant decreasing effect over time. Extension of the cold ischemic period (>24h) exerts a permanent detrimental effect on the grafts. The use of organs obtained from old donors contributes significantly to late graft loss. A persistent negative effect was seen in case of female donors to male recipients, the opposite was found for male to female. Conclusions: Non-immunological factors have a constant detrimental effect on graft failure, while the impact of the immunological factors, although remaining important, slowly decreases over time. In the context of marginal transplants, clustering of unfavourable factors should be avoided in order to prevent late graft losses.Table