BACKGROUND: Renal dysfunction measured by serum creatinine (>1.5 mg/dL) at 1 year post-transplant correlates with long-term kidney graft survival. The purpose of this study was to compare the risk factors for elevated serum creatinine (SCr) >1.5 mg/dL at 1 year post-transplantation, and for long-term graft failure. METHODS: Between 1988 and 1999, 117,501 adult kidney transplants were reported to Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS). Of these, 96,091 were functioning at 1 year and SCr was available on 85,135 transplants. Donor and recipient demographics (age, sex, and race), transplant [living vs. cadaveric, previous transplantation, panel reactive antibody (PRA), human leukoocyte antigen (HLA) mismatch, cold ischemic time (CIT) and post-transplant delayed graft function (DGF), use of azathioprone vs. mycophenolate mofetil (MMF), cyclosporine A (CsA) vs. tacrolimus (Tac)], induction antibody, acute rejection within 1 year variables were used in the logistic regression model to estimate odds ratio (OR) for elevated 1 year serum creatinine (SCr). A Cox proportional hazard model was used to estimate the relative risk (RR) for long-term kidney graft failure with and without censoring for death with a functioning graft. RESULTS: Five-year actuarial graft survival for living donor transplant with SCr >1.5 and </=1.5 mg/dL at 1 year post-transplant was 83% and 88.6% (P < 0.001). The corresponding values for cadaveric transplant grafts were 66.5% and 77.9% (P < 0.001). The overall prevalence of renal dysfunction at 1 year post-transplant (SCr >1.5 mg/dL) declined from 54.5% in 1988 to 42.3% in 1999. There was a strong concordance between the key variables, such as cadaveric transplant, increasing CIT, HLA mismatch, DGF, and acute rejection, recipient race (black), younger age, and nondiabetics status; and donor race (black) and older age for elevated SCr and long-term graft failure. CONCLUSION: Donor (age), race (black), recipient race (black), immunologic variables (HLA mismatch, DGF, acute rejection) were identified as important risk factors for elevated SCr at 1 year post-transplantation and long-term graft failure. Elevated SCr should be used as a short-term marker for predicting long-term transplant survival.
BACKGROUND:Renal dysfunction measured by serum creatinine (>1.5 mg/dL) at 1 year post-transplant correlates with long-term kidney graft survival. The purpose of this study was to compare the risk factors for elevated serum creatinine (SCr) >1.5 mg/dL at 1 year post-transplantation, and for long-term graft failure. METHODS: Between 1988 and 1999, 117,501 adult kidney transplants were reported to Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS). Of these, 96,091 were functioning at 1 year and SCr was available on 85,135 transplants. Donor and recipient demographics (age, sex, and race), transplant [living vs. cadaveric, previous transplantation, panel reactive antibody (PRA), human leukoocyte antigen (HLA) mismatch, cold ischemic time (CIT) and post-transplant delayed graft function (DGF), use of azathioprone vs. mycophenolate mofetil (MMF), cyclosporine A (CsA) vs. tacrolimus (Tac)], induction antibody, acute rejection within 1 year variables were used in the logistic regression model to estimate odds ratio (OR) for elevated 1 year serum creatinine (SCr). A Cox proportional hazard model was used to estimate the relative risk (RR) for long-term kidney graft failure with and without censoring for death with a functioning graft. RESULTS: Five-year actuarial graft survival for living donor transplant with SCr >1.5 and </=1.5 mg/dL at 1 year post-transplant was 83% and 88.6% (P < 0.001). The corresponding values for cadaveric transplant grafts were 66.5% and 77.9% (P < 0.001). The overall prevalence of renal dysfunction at 1 year post-transplant (SCr >1.5 mg/dL) declined from 54.5% in 1988 to 42.3% in 1999. There was a strong concordance between the key variables, such as cadaveric transplant, increasing CIT, HLA mismatch, DGF, and acute rejection, recipient race (black), younger age, and nondiabetics status; and donor race (black) and older age for elevated SCr and long-term graft failure. CONCLUSION:Donor (age), race (black), recipient race (black), immunologic variables (HLA mismatch, DGF, acute rejection) were identified as important risk factors for elevated SCr at 1 year post-transplantation and long-term graft failure. Elevated SCr should be used as a short-term marker for predicting long-term transplant survival.
Authors: Caragh P Stapleton; Andreas Heinzel; Weihua Guan; Peter J van der Most; Jessica van Setten; Graham M Lord; Brendan J Keating; Ajay K Israni; Martin H de Borst; Stephan J L Bakker; Harold Snieder; Michael E Weale; Florence Delaney; Maria P Hernandez-Fuentes; Roman Reindl-Schwaighofer; Rainer Oberbauer; Pamala A Jacobson; Patrick B Mark; Fiona A Chapman; Paul J Phelan; Claire Kennedy; Donal Sexton; Susan Murray; Alan Jardine; Jamie P Traynor; Amy Jayne McKnight; Alexander P Maxwell; Laura J Smyth; William S Oetting; Arthur J Matas; Roslyn B Mannon; David P Schladt; David N Iklé; Gianpiero L Cavalleri; Peter J Conlon Journal: Am J Transplant Date: 2019-03-28 Impact factor: 8.086
Authors: S Peacock; D Briggs; M Barnardo; R Battle; P Brookes; C Callaghan; B Clark; C Collins; S Day; N Diaz Burlinson; P Dunn; R Fernando; S Fuggle; A Harmer; D Kallon; D Keegan; T Key; E Lawson; S Lloyd; J Martin; J McCaughan; D Middleton; F Partheniou; A Poles; T Rees; D Sage; E Santos-Nunez; O Shaw; M Willicombe; J Worthington Journal: Int J Immunogenet Date: 2021-09-23 Impact factor: 2.385
Authors: Brian Y Young; Jagbir Gill; Edmund Huang; Steven K Takemoto; Bishoy Anastasi; Tariq Shah; Suphamai Bunnapradist Journal: Clin J Am Soc Nephrol Date: 2009-02-06 Impact factor: 8.237
Authors: A Shaked; R M Ghobrial; R M Merion; T H Shearon; J C Emond; J H Fair; R A Fisher; L M Kulik; T L Pruett; N A Terrault Journal: Am J Transplant Date: 2008-12-15 Impact factor: 8.086
Authors: Sharon R Weeks; Xun Luo; Christine E Haugen; Shane E Ottmann; Ahmet O Gurakar; Fizza F Naqvi; Saleh A Alqahtani; Benjamin Philosophe; Andrew M Cameron; Niraj M Desai; Dorry L Segev; Jacqueline M Garonzik Wang Journal: Transplantation Date: 2020-03 Impact factor: 5.385