Donor and preservation factors.

1. In nonsensitized, white recipients of first cadaver donor transplants, 1-year graft survival was: 13% lower when the donor was black than when the donor was white; 7-9% lower when the kidney was from a pediatric (under 15) or older (over 50) donor than from a donor aged 21-50; 8% lower when the donor was a female over 30 than when the donor was a male under 30; 4% lower when the cause of donor death was a cerebrovascular accident than when the death was a closed head injury; 6% lower when the kidney was transplanted with more than 36 hours of cold ischemia time than when ischemia was less than 24 hours; 3% lower if the kidney had been transported more than 50 miles to the transplant center. 2. The lower graft survival rates associated with the race, sex, age and cause of death of the donor were generally reflected in a higher incidence of early nonfunction and poorer quality of function. 3. Preservation related factors, long cold ischemia and sharing were associated with an increase in delayed onset of function, but there was no difference in the proportion of kidneys that never functioned during the follow-up period. 4. There was a 9% difference in 1-year graft survival between kidneys obtained from centers more than 50 miles from the transplant center and with more than 36 hours of cold ischemia and those transplanted locally with less than 24 hours of cold ischemia. 5. Long cold ischemia, even in excess of 48 hrs, had no effect on graft survival when the kidney was procured locally. Long cold ischemia in the absence of sharing was not an apparent risk factor. 6. Rather than concluding that distant sharing results in kidneys of poor quality, we may have to consider that kidneys of poor quality are sometimes shared. 7. Cadaver kidneys from female donors over 30 had 80% 1-year survival when transplanted to recipients who weighed between 41 and 75 kg, a result comparable to that obtained with young male donor organs. In recipients over 75 kg, survival of the older female kidneys was 70% vs 80% for young male donor kidneys. Recipient "size" may be a nonimmunological risk factor.