Factors affecting the long-term renal allograft survival

Background In the past decades,the one-year graft survival of cadaveric renal allografts has been markedly improved,but their long-term survival has not kept pace.The attrition rate of renal allografts surviving after one year remains almostunchanged.The causes for late graft loss are multiple.The aim of this study was to analyze the predictive factors thatimpact long-term survival of grafts after kidney transplantation.Methods We retrospectively analyzed 524 kidney transplantation patients who were treated in our hospital betweenJanuary 1991 and January 2000,including 254 patients who had lived more than 10 years with normal graft function(long survival group),and 270 cases whose renal graft had survived less than 10 years (control group).Specifically,weanalyzed 10 factors that may potentially affect graft survival by both univariate and Logistic model multivariate analysesto pinpoint the independent risk factors.Results Univariate analyses showed that no significant differences existed in the age or gender of recipients,dialysistime,lymphotoxin levels,or cold ischemia time between the two groups.However,the ratio of delayed graft function andacute rejection,and the uric acid levels of patients in the long survival group were significantly lower than those in thecontrol group (P<0.01).Furthermore,we found that the concentration of cyclosporin A at one year after transplantationand the histocompatibility antigen match of donor-recipients for patients within the long survival group were significantlyhigher than those in the control group (P<0.01).Furthermore,multivariate analyses showed that these four factors wereindependent risk factors that impact patient survival.Conclusions The ratios of delayed graft function and acute rejection,the concentration of cyclosporin A at one yearafter transplantation,and serum uric acid levels are very important factors that affect the long-term survival of renal grafts.