Clinical significance of slow recovery of graft function in living donor kidney transplantation.
BACKGROUND
The clinical significance of slow recovery of graft function (SGF) in living donor kidney transplantation is unclear. We evaluated the incidence, risk factors, and clinical outcome of SGF in living donor transplantation.


METHODS
Three hundred ten living donor kidney recipients were included and categorized into immediate recovery of graft function (IGF; n=239) and SGF (n=71), according to estimated glomerular filtration rate (60 mL/min/1.73 m) at posttransplant day 14. We compared the clinical parameters, protocol biopsy findings, acute rejection (AR), and 10-year graft survival between the two groups.


RESULTS
The SGF group had an older recipient age, lower ratio of donor to recipient body mass index, and higher incidence of AR than IGF group, as shown by protocol biopsies. The SGF group had significantly more AR episodes than IGF group within 12 months (21.1% vs. 13.4%, P<0.05) and during follow-up period (32.4% vs. 20.1%, P<0.05). The 10-year graft survival rate did not differ between groups, but AR presence was significantly associated with a lower graft survival in the SGF group than the IGF group (64.9% vs. 78.9%, P<0.05).


CONCLUSIONS
SGF in the early posttransplant period is immunologically active and should be considered as one of the risk factors for determining long-term graft survival in living donor kidney transplantation.
Lee
So Young
SY
Department of Internal Medicine, Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, SeoCho-Ku, Seoul, Korea.
Chung
Byung Ha
BH
Piao
Shang Guo
SG
Kang
Seok Hui
SH
Hyoung
Bok Jin
BJ
Jeon
Youn Joo
YJ
Hwang
Hyeon Seok
HS
Yoon
Hye Eun
HE
Choi
Bum Soon
BS
Kim
Ji-Il
JI
Moon
In Sung
IS
Kim
Yong-Soo
YS
Choi
Yeong Jin
YJ
Yang
Chul Woo
CW
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome
D003404:Creatinine