The importance of prolonged post‐transplant dialysis requirement in cyclosporine‐treated renal allograft recipients

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Abstract
Eighty‐six consecutive cyclosporine‐treated recipients of cadaver donor renal allografts were studied to examine the long‐term effect of prolonged posttransplantation dialysis requirement. Overall, 1‐yr actuarial patient survival was 93% and 1‐yr actuarial graft survival was 71%. Group I patients (0 or 1 dialysis, n = 44) had a 1‐yr actuarial graft survival of 88% compared to Group 3 patients (>5 dialyses, n = 25) who had a 38% actuarial 1‐yr graft surival (p = 0.0004). Group 3 patients who eventually became dialysis‐independent (n = 18) had a 1‐yr actuarial graft survival of 53%, (p=0.0125 compared to Group 1). Furthermore, Group 3 patients retaining allograft function 1 yr after transplantation had a significantly higher mean serum creatinine, 2.70 ± 0.25 mg/dl, compared to 1.66 ± 0.12 mg/dl in Group I patients (p=0.001), despite similar cyclosporine levels. One‐year actuarial patient survival was 98% in Group I, 100% in Group 2 (2–5 dialysis treatments, n = 17), and 79% in Group 3 (p = 0.01). Multivariate analysis revealed that cold storage of allografts (compared to machine perfusion) and a history of prior renal transplants were the main risk factors for prolonged post‐transplant dialysis requirement. When controlled for multiple immunologic risk factors such as prior transplants, ATG therapy, pulse steroid therapy and high cytotoxic antibody levels, prolonged postoperative dialysis therapy did not emerge as an independent predictor of graft loss. We conclude that delayed graft function imparts a poorer prognosis principally because of its association with immunologic risk factors for graft loss.