One-year posttransplant renal function is a strong predictor of long-term kidney function: results from the Neoral-MOST Observational Study.
BACKGROUND
Peritransplant risk factors influence short-term and long-term graft survival, and 1-year serum creatinine is known to predict long-term graft survival. To examine interrelationships between risk factors, renal function at 1 year, and long-term graft function in patients maintained on cyclosporine, we analyzed data collected from 10,692 de novo or maintenance renal transplant recipients in an ongoing international, prospective, observational study--Neoral-MOST (Multinational Observational Study in renal Transplantation). The effect of donor age, delayed graft function, acute rejection, donor type, panel-reactive antibodies, and previous graft on 1- and 5-year renal function and their relationship to 1-year serum creatinine was assessed.


RESULTS
Donor age, delayed graft function, acute rejection, and donor type significantly increased the risk for serum creatinine > 130 micromol/L at 1 year posttransplant, and 1-year serum creatinine was the strongest predictor of 5-year renal function. After adjustment for 1-year serum creatinine, an ongoing influence was observed for donor age, donor type, and previous graft. Delayed graft function and acute rejection had a significant effect on serum creatinine at year 1 but no additional impact on long-term graft function.


CONCLUSIONS
Serum creatinine at 1 year is influenced by risk factors known to affect overall graft survival and is predictive of 5-year renal graft function. The effects of delayed graft function and acute rejection appear to be limited to their influence on serum creatinine at 1 year, whereas donor type and previous graft predominantly affect later stages of graft life.
Salvadori
M
M
Department of Renal Transplantation, Careggi University Hospital, Viale Pieraccini 18, Tuscany, Florence 50139, Italy.
Rosati
A
A
Bock
A
A
Chapman
J
J
Dussol
B
B
Fritsche
L
L
Jeffery
J
J
Kliem
V
V
Lebranchu
Y
Y
Oppenheimer
F
F
Pohanka
E
E
Tufveson
G
G
D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology* / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000502:physiology / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine