Evolution of the renal function is a better predictor of long-term survival than serum creatinine.
BACKGROUND
In recent years acute rejection has decreased to 10% to 20%. Therefore it is necessary to look for new endpoints in renal transplantation. Serum creatinine and changes in creatinine have been reported to be powerful predictors of long-term kidney transplant survival. Chronic renal allograft nephropathy is the primary cause of long-term graft failure but may appear at any stage in the evolution.


METHODS
Data from 315 patients receiving cadaver donor renal transplants between February 1987 and March 2001 that functioned for 1 year were examined for the influence of demographic characteristics and transplant variables. Creatinine clearance was estimated using the Cockroft-Gault formula. Survival was assessed with the actuarial method. The multivariate analyses were performed using Cox proportional hazard models.


RESULTS
The 10-year graft survival showed a relative risk of 2.5 in the univariate analysis when there was more than 10% decrease in renal function at 3 months compared with nadir values. When the decrease was more than 25% of creatinine clearance at the third month, during the evolution and serum creatinine at 3 months introduced in the multivariate model, the latter was not significant, while the other variables had a RR of 4.4 and 10, respectively.


CONCLUSIONS
The evolution of renal function at 3 months and throughout the evolution were better predictors of graft failure than an isolated serum creatinine value.
Marqués
G Gómez
GG
Renal Unit, University Hospital of Son Dureta, Palma de Mallorca, Spain. ggmarques@ono.com
Goenaga
P Errasti
PE
Royo
F J Lavilla
FJ
Escolá
J Manrique
JM
García Fernández
N
N
Unanua
A Purroy
AP
D000328:Adult; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors
D003404:Creatinine