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The Relationship Between Donor Age and Cadaveric Renal Allograft Survival Is Modified by the Recipient's Blood Pressure
Author(s) -
Cosio Fernando G.,
Henry Mitchell,
Pesavento Todd E.,
Ferguson Ronald M.,
Kim Sunny,
Lemeshow Stanley
Publication year - 2003
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1034/j.1600-6143.2003.00064.x
Subject(s) - medicine , hazard ratio , creatinine , blood pressure , renal function , cadaveric spasm , urology , transplantation , kidney , kidney transplantation , proportional hazards model , survival analysis , surgery , survival rate , confidence interval
Increasing donor age correlates with reduced renal allograft survival. In this study we analyzed variables that may modify this relationship. The study included 1285 cadaveric kidney allograft recipients followed for 7.2 + 4.5 years. By Cox, increasing donor age beyond 30 years was associated with significant increases in the hazard ratio for graft loss [age 31–46, hazard ratio (HR) = 1.4, p = 0.02; 46–60, HR = 1.55, p = 0.008; > 60, HR = 1.68, p = 0.03]. Increasing donor age was significantly associated with: older and heavier recipients; higher creatinine and blood pressure (BP) 6 months post‐transplant; and lower total cyclosporine dose during the first year. Of interest, the 6‐month serum creatinine and the BP level modified significantly the relationship between age and survival. Thus, increasing donor age was significantly related to reduced graft survival only in patients with a 6‐month creatinine < 2 mg/dL. Furthermore, donor age related significantly to graft survival only among patients with higher BP levels 6 month post transplant. It is concluded that increasing donor age is associated with reduced cadaveric graft survival, but that relationship is significantly modified by graft function and BP. These data suggest that poorly functioning kidneys have reduced survival irrespective of age. Furthermore, elevated BP levels may have a particularly negative effect on the survival of older grafts .