Our purpose was to study the factors predictive of graft loss or patient death within 3 yr of renal transplant in a county population. 363 renal transplants performed between 1984 and 1991 at the Harbor-UCLA Medical Center were reviewed. There were 16 recipients (4%) who died and 76 (21%) who lost their grafts within 3 yr. Known causes of death were cardiac (44%), infection (38%) and malignancy (6%). There was a higher proportion of diabetics (44%), hypertensives (69%) and those with a past cardiac history (38%). Then was also a high delayed graft function rate (56%). Of the 76 grafts that failed in the first 3 yr, 14% were due to noncompliance, 20% to grafts that never functioned, 9% to technical problems, 21% to acute rejection, 9% to recurrent disease and 26% to chronic rejection. The noncompliance group were younger (mean 34 pr), and more likely to be a first transplant (90%) and be non-white (82%). The rejection group was significant for high delayed graft function rate (84%) and frequent and early rejection (76% at least one rejection). We conclude that fair organ allocation requires a balance between equity and utility, but patient death or graft loss within 3 yr benefits neither the patient or society. Patient survival may be improved with diligent cardiac evaluation, particularly in older patients and diabetics. Patient education and monitoring for noncompliance is essential, particularly in young first-time recipients. Maneuvers to decrease delayed graft function are essential to improve long-term results.
机构:
Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China
Wu, J. F.
Guan, X. -D.
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Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China
Guan, X. -D.
Chen, J.
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Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China
Chen, J.
Ou-Yang, B.
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Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China
机构:
Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
Wu, Jian-Feng
Wu, Rong-Yao
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Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
Wu, Rong-Yao
Chen, Juan
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Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
Chen, Juan
Bin Ou-Yang
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Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
Bin Ou-Yang
Chen, Min-Ying
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Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
Chen, Min-Ying
Guan, Xiang-Dong
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Sun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R ChinaSun Yat Sen Univ, Affiliated Hosp 1, Dept Surg Intens Care Unit, Guangzhou 510080, Guangdong, Peoples R China
机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Nanashima, A
Pillay, P
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Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, AustraliaUniv Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Pillay, P
Verran, DJ
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Verran, DJ
Painter, D
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Painter, D
Nakasuji, M
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Nakasuji, M
Crawford, M
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Crawford, M
Shi, L
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia
Shi, L
Ross, AG
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机构:Univ Sydney, Royal Prince Alfred Hosp, Australian Natl Liver Transplantat Unit, Sydney, NSW 2050, Australia