title: Long-term outcome of deceased donor renal transplants correlates with the 30-day creatinine reduction ratio.
abstract: A simplified model to correlate early allograft function with long-term allograft survival in recipients of deceased donor renal transplants (DDRT) remains challenging. We propose here a novel approach, using the change from the pretransplant creatinine to the 30-day posttransplant creatinine. The outcomes of 153 consecutive DDRT performed at our center between January 1998 and March 2001 were reviewed. The percentage change in creatinine from the pretransplant to 1 month posttransplant, termed here, the creatinine reduction ratio (CRR), was calculated as follows: (pretransplant creatinine-creatinine at 1 month)/pretransplant creatinine *100%. Patients were divided as follows: group 1 CRR>or=67% and group 2<67%. Group 1 had a graft survival at 1 and 5 years of 100% and 89.1% versus 88% and 69.1% for group 2 (log-rank p=0.0008). The risk ratio for graft loss during the follow-up period was four times lower for the patients on group 1. Using the Cox hazards model to compare CRR>or=67% with determinants of long-term outcome, the risk ratio of graft loss during the observational period was 0.26 (p=0.001). The creatinine reduction ratio, when stratified by a level of >or=67% has a strong correlation with superior long-term allograft survival in recipients of DDRT.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Iowa School of Medicine, Iowa City 52242, Iowa, USA. roberto-kalil@uiowa.edu
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Kalil
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Dyer
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Rayhill
mesh_terms: D000328:Adult; D002102:Cadaver; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007674:Kidney Diseases / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009399:Nephrons / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine