FACTORS INFLUENCING THE OUTCOME OF RENAL TRANSPLANTATION

Multivariate Analysis of Preoperative Factors

Abstract

The major preoperative factors that may affect the outcome of related donor renal transplantation are histocompatibility, preoperative blood transfusions, and presensitizations. Dosage of immunosuppressive drugs, number of rejection episodes and postoperative complications may also determine the result of clinical renal transplantation. Most reports on factors related to renal transplantation have employed univariate analysis or, at best, bivariate analysis. Reports using multivariate methods are lacking, due to the complexity of the clinical situation surrounding renal transplantation. The purpose of this paper is to extend the multivariate analysis and explore those factors that may be associated with the outcome of transplant functional survival. A retrospective analysis was undertaken of 134 first living related renal transplants at Kitasato University Hospital. We screened the following variables for their association with the graft survival: recipient age, sex, original disease, ABO-type, duration of hemodialysis, blood transfusion 6 months prior to transplantation, donor age, sex, preoperative renal function and histocompatibility (HLA mismatch) using the Cox regression model.
The analysis of our data indicated that the Cox model seems to be a useful tool to assess the influence of each variable on graft survival results, while the effects of all other variables are fixed. Of the variables screened for their association with the graft survival, recipient age and HLA mismatch had significant effects on graft survival all through the periods. Preoperative blood transfusion had negative effects for the first three months and positive effefts over three years postoperatively and recipient age is highly significant factor for the first one year.