title: The detrimental effect of poor early graft function after laparoscopic live donor nephrectomy on graft outcomes.
abstract: We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine >/= 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34-3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10-2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92-3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44-4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. jnogueir@medicine.umaryland.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Nogueira
authors.forename: A
authors.initials: A
authors.lastname: Haririan
authors.forename: S C
authors.initials: SC
authors.lastname: Jacobs
authors.forename: M R
authors.initials: MR
authors.lastname: Weir
authors.forename: H A
authors.initials: HA
authors.lastname: Hurley
authors.forename: H S
authors.initials: HS
authors.lastname: Al-Qudah
authors.forename: M
authors.initials: M
authors.lastname: Phelan
authors.forename: C B
authors.initials: CB
authors.lastname: Drachenberg
authors.forename: S T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: M
authors.initials: M
authors.lastname: Cooper
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D006435:Renal Dialysis; D012307:Risk Factors; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D052096:Warm Ischemia
chemical_list: D003404:Creatinine