The combined impact of donor age and acute rejection on long-term cadaver renal allograft survival

Background: Acute rejection (AR) is an important risk factor for long- term renal graft loss. Furthermore, donor age is also associated with graft outcome. We analyzed the combined effects of cadaver donor age and AR on long-term graft survival. Methods: A retrospective review was made of 112 cadaver renal transplants at a single center. Only grafts functioning at least 3 months were included in this analysis. Results: The 3-year survival of AR-free grafts was superior to that of grafts with AR (98% vs 67%, P < .001). Within the AR cohort donor age >50 years (P < .05) had an additional negative impact on graft survival. The 3-year survival of an older donor graft with AR was 33% versus 82% for a younger donor graft with AR. Conclusions: AR was a significant predictor of long-term graft loss. Older donor kidneys with AR had poorer graft survival than did younger donor kidneys with AR.