title: Recovery of graft function early posttransplant determines long-term graft survival in deceased donor renal transplants.
abstract: BACKGROUND
  Because kidneys show remarkable resilience and can recover function, we examined the impact on long-term graft survival in deceased donor renal transplants of both immediate graft function (IGF) and the rate of renal function recovery over the first 3 months after transplantation.
  
  
  METHODS
  We included all cadaveric renal transplants from 1990 to 2007 (n = 583). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined by serum creatinine falls of <20% or >20% in the first 24 hours posttransplant respectively. Recovery of renal function was expressed as either the best creatinine clearance (CrCl) in the first 3 months post-renal transplantation (BCrCl-3mos) as calculated using the Cockcroft-Gault formula or as a percentage of actual versus expected value (as calculated from the donors' CrCl at procurement).
  
  
  RESULTS
  There were 140 (23.6%) subjects who received extended criteria donor (ECD) organs. The overall graft survival at 1 and 5 years was 87.8% and 74%, respectively. The 5-year graft survivals for patients with IGF, SGF, and DGF were 85%, 76%, and 54%, respectively (P < .02). ECD kidneys showed twice the DGF rate (49% vs 23%, P < .001). BCrCl-3mos of <30 mL/min displayed a 5-year graft survival of 34%; 30 to 39 mL/min, 72%; 40 to 49 mL/min, 85%; and >50 mL/min, 82% (P < .001). Similarly, a recovery within 90% of expected CrCl in the first 3 months posttransplant correlated with 5-year graft survival of 81%; a recovery of 70% to 90%, with 65%; and a recovery of <70%, with 51% (P < .001).
  
  
  CONCLUSIONS
  Early graft function in the first 3 months showed a significant impact on long-term graft survival after deceased donor renal transplantation.
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Hassanain
authors.forename: J I
authors.initials: JI
authors.lastname: Tchervenkov
authors.forename: M
authors.initials: M
authors.lastname: Cantarovich
authors.forename: P
authors.initials: P
authors.lastname: Metrakos
authors.forename: S
authors.initials: S
authors.lastname: Paraskevas
authors.forename: D
authors.initials: D
authors.lastname: Keith
authors.forename: D
authors.initials: D
authors.lastname: Baran
authors.forename: M
authors.initials: M
authors.lastname: Fernandez
authors.forename: R
authors.initials: R
authors.lastname: Mangel
authors.forename: P
authors.initials: P
authors.lastname: Chaudhury
mesh_terms: D002102:Cadaver; D003404:Creatinine / Q000378:metabolism; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D018579:Patient Selection; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D003404:Creatinine