The effect of the referring dialysis center on renal transplant results

Between 1/1/76 and 12/31/86, 448 patients underwent transplantation (360 first transplants). Of these, 286 (230 first) were referred by 5 dialysis centers, each referring more than 40 recipients. The remainder were referred by a large number of centers. Using our 5 largest referral centers, we studied the effect of dialysis center on graft and patient survival. There was no difference between dialysis centers in patient survival. Actuarial graft survival differed sig-nificantly for all cadaver transplants and for first cadaver transplants (P < 105). Significant differences persisted when groups were subdivided by type of im-munosuppression (azathioprine vs cyclosporine). De-mographic (age, race, cause of renal disease) and im-munologic (transfusions, PRA, matching) differences between groups did not explain the difference in graft survival. We conclude that referring dialysis center is a previ-ously unrecognized factor affecting transplant outcome. Further studies with larger numbers will be required to determine the underlying reasons for ths phenomenon.