Does timing of post-renal transplant diuresis affect graft survival in live-donor renal transplants?
OBJECTIVE
To study the effect of timing of diuresis on short and long term graft survival in live-donor (LD) renal transplants.


METHODS
Between 1976 and 2005, 1747 consecutive LD renal transplants were performed in a single institution. Patients were classified according to timing of diuresis after vascular de-clamping; group 1 included patients with diuresis within 10 min; group 2 started diuresis between 10 and 60 min after de-clamping; group 3 started diuresis between 1 and 24 h after de-clamping; and group 4 started diuresis > 24 h after de-clamping. Patients' data were stored on an electronic database and were reviewed for risk factors and clinical relevance of timing of diuresis.


RESULTS
Groups 1-4 comprised 1598 (91.5%), 87 (5%), 44 (2.5%) and 18 (1%) patients, respectively. By multivariate analysis, vascular thrombosis was the significant risk factor for delayed diuresis. Delayed diuresis was significantly associated with the occurrence of acute tubular necrosis (ATN), and acute and chronic rejection. Graft and patient survival rates were significantly affected by the timing of diuresis. The 1-year graft survival rates were 93.8, 83.0, 83.6 and 55.6%, and the 5-year graft survival rates were 77.4, 59.4, 69.4 and 35.7% in groups 1, 2, 3 and 4, respectively (P < 0.001). The 1-year patient survival rates were 96.5, 84.4, 90.7 and 61.1% and the 5-year patient survival rates were 87.1, 72.0, 78.1 and 52.4% in groups 1, 2, 3 and 4, respectively (P < 0.001).


CONCLUSIONS
Delayed diuresis is a rare event after LD renal transplantation, which has an adverse effect on short- and long-term graft and patient survival.
Osman
Yasser
Y
Urology & Nephrology Centre, Mansoura University, Egypt. y_osman99@yahoo.com
El-Husseini
Amr
A
Kamal
Mohamed
M
Refaie
Ayman
A
Sheashaa
Hussein
H
Sobh
Mohamed
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004231:Diuresis / Q000502:physiology*; D004812:Epidemiologic Methods; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult