Risk factors for rising creatinine in renal allografts with 1 and 3 yr survival.
BACKGROUND
Determining factors associated with negative slope of inverse creatinine vs. time (1/Cr vs. t) may help prevent a decline in renal allograft function.


METHODS
A total of 1389 adult recipients of primary renal transplants were divided into quartiles based on the slope of 1/Cr vs. t calculated from 6 and 12 months post transplant. A multivariate analysis of risk factors for being in the worst vs. best quartile employed these variables: donor source, HLA mismatch, recipient age, donor age, panel-reactive antibody (PRA), acute rejection (AR), 3-month cyclosporin A (CsA) level, 1-yr CsA level and acute tubular necrosis. Two separate analyses compared risk factors in patients with 1 and 3 yr survival, respectively.


RESULTS
In recipients with > or = 1 yr graft survival, high PRA and AR were associated with negative slopes of 1/Cr vs. t. For those with > or = 3 yr graft survival, both AR and 3-month CsA level > 150 ng/mL were significant risk factors, using both 6- and 12-month slopes. Stratification of AR showed 1 AR episode > or = 6 months and multiple AR episodes carried significant risk for negative slopes.


CONCLUSIONS
Optimization of allograft function invokes a conundrum between the needs to avoid both AR and high early CsA levels. We support a policy of carefully balancing these two risks.
Paraskevas
Steven
S
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Kandaswamy
Raja
R
Humar
Abhinav
A
Gillingham
Kristen J
KJ
Gruessner
Rainer W
RW
Payne
William D
WD
Najarian
John S
JS
Sutherland
David E R
DE
Matas
Arthur J
AJ
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood* / Q000150:complications; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous
D015415:Biomarkers; D003404:Creatinine