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JERZY SIEŃKO

IMPACT OF SOME IMMUNOLOGICAL AND NON-IMMUNOLOGICAL FACTORS
ON EARLY AND DISTANT FUNCTION OF TRANSPLANTED KIDNEY

Summary
Objectives: Transplantation is the best method of treatment of end-stage renal disease [15, 27, 40]. Unfortunately, not every transplantation is successful (loss or delayed graft function, short time of graft function, recipient’s death). Delayed graft function and acute rejection episodes may shorten graft survival [12]. There are many others factors which may affect graft function. The aim of the study was to determine factors which affect early graft function and time of graft functioning, as well as the overall effect of graft function time on the recipient’s survival. Methods: 442 renal graaft recipients were enrolled in this retrospective study. Transplantations were done between 1990 and 1995 at the Department of General and Transplantation Surgery, Pomeranian Medical University, and the Department of Surgery, Provincial Hospital in Szczecin. 312 patients with immediate graft function (IGF) and 130 patients with delayed or no graft function (DGF and NGF) formed the two study groups. The donor’s and recipient’s age and gender, cause of end-stage renal disease, cause of donor’s death, donor’s and recipient’s HLA phenotype and AB0 blood group, time of hemodialysis before transplantation, PRA titre, cold and warm ichaemic time, and the recipient’s viral status were analyzed. Statistical analysis was done with the Statistica 5 PL package using a logistic regression model, log rank test, and Cox regression. Results: AB0 incompatibility, long warm ischaemia time, and high PRA titre were the most important independent factors predicting graft function disorders. Rh incompatibility, old donor, long cold ischaemia time, presence of HBs antigen and HCV antibodies were independent factors predicting no graft function. The log rank test revealed a significantly longer survival of IGF patients. The risk of death in DGF patients was 1.47 higher than for IGF. Longer time of graft function correlated significantly with longer recipient’s survival. Conclusions: l. Young age of donor, minimal cold ischaemia time and AB0 compatibility increase the chances for normal graft function. 2. Short warm ischaemia time, AB0 compatibility, maximal HLA compatibility, and low PRA titre predict longer graft function. 3. Longer time of graft function is associated with a longer survival time of the recipient.


K e y w o r d s : kidney transplantation – donor – recipient – HLA – cold and warm ischemic time – period of dialysis – graft function time.

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