Recovery of graft function early posttransplant determines long-term graft survival in deceased donor renal transplants.
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.
Hassanain
M
M
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Tchervenkov
J I
JI
Cantarovich
M
M
Metrakos
P
P
Paraskevas
S
S
Keith
D
D
Baran
D
D
Fernandez
M
M
Mangel
R
R
Chaudhury
P
P
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
D003404:Creatinine