Preservation.

Abstract

1. Cyclosporine treatment did not increase nonfunction for one month, delayed function, or first-day nonfunction in comparison with noncyclosporine-treated patients. Despite almost equivalent initial poor function rates, cyclosporine-treated patients had a higher one-year graft survival rate than noncyclosporine-treated patients. Thus, unlike many other factors, cyclosporine did not have its main effect during first-month function. 2. In regrafts there was a higher incidence of one-month and one-day nonfunction. However, these poor-function categories were not significantly increased in cyclosporine-treated patients. 3. Warm ischemia longer than 10 minutes increased the rate of first-day nonfunction and delayed function. 4. Cold ischemia longer than 36 hours increased the rate of first-day nonfunction, delayed function, and one-month nonfunction. Cyclosporine-treated patients with 36 to 48 hours cold ischemia had a one-year graft survival rate of 76% compared with 68% for those with kidneys preserved longer than 48 hours. 5. One-year graft survival rates were similar for machine- and cold-preserved kidneys if cyclosporine was used, although machine preservation led to slightly less early poor function. 6. Cyclosporine had a beneficial effect for first grafts and regrafts preserved by cold storage. However, it had an adverse effect in machine-preserved kidneys for regrafts. 7. In cyclosporine-treated patients, kidneys with delayed function had a higher (3% at one year) survival rate than those with immediate function. This was reversed in noncyclosporine-treated patients where immediate-function kidneys had a 6% higher one-year graft survival rate than those with delayed function. The same relationships held for regrafts. 8. Cyclosporine improved the one-year graft survival of delayed-function grafts by 21% in first grafts and 12% in regrafts. For kidneys which immediately functioned, cyclosporine therapy increased the one-year graft survival rate by 11% for first grafts and 3% for regrafts. Thus, cyclosporine appears to have a greater influence on kidneys with delayed function than on those with immediate function. 9. The incidence of kidneys that did not function for one month was higher (15%) in regraft patients than in first graft patients (8%). The frequency of delayed function was approximately the same for regrafts and first grafts. Thus, the main difference between first and regrafted patients occurs in the higher incidence of kidneys that never functioned among regrafted patients.