Donor factors.

1. Kidneys from female donors between the ages of 31 and 50 had consistently poorer graft survival rates than kidneys from male donors or younger female donors. 2. Sensitized first cadaver kidney recipients of older female donor kidneys had a one-year graft survival rate of 65% as compared with 82% in recipients of young male donor grafts (p less than 0.001). Retransplanted recipients of older female donor grafts had a one-year graft survival rate of 48% as compared with 70% in recipients of young male donor kidneys (p less than 0.001). 3. The effects on graft survival of donor age and sex were considerably greater than the effect of cold ischemia in excess of 36 hours. 4. The cause of donor death was a risk factor for sensitized and regraft recipients. In data from 45 transplant centers, sensitized first transplant recipients of nontrauma donor kidneys had a one-year graft survival rate of 67% versus 78% (p = NS) for recipients of trauma donor kidneys. Regraft recipients of nontrauma donor grafts had a one-year graft survival rate of 55% versus 67% (p less than 0.05) for recipients of trauma donor kidneys. 5. The cause of donor death effect and the effects of donor age and sex may be related as older female donors accounted for 37% of nontrauma donors and only 7% of trauma donors were older females. 6. A surprisingly high percentage of older female (6%) and nontrauma donor kidneys (3%) failed on the first day posttransplant in regrafted patients. A very sensitive crossmatch may help reduce the number of immediate failures. 7. HLA matching improved graft survival of female donor kidneys to a greater extent than male donor kidneys in regrafted patients. With zero or one mismatch at HLA-B,DR there was no difference in one-year graft survival between male and female donor kidneys. In first cadaver transplants, the difference in graft survival between older female and young male donor grafts was minimized by very good matching. Matching also abrogated the donor sex and age effects in living-related donor transplants. 8. Sensitized patients and patients who have previously rejected a kidney should be given priority for young male trauma donor organs when these become available.