title: Early graft function after laparoscopically procured living donor kidney transplantation.
abstract: OBJECTIVE
  We determined predictors of poor early graft function after laparoscopic living donor kidney transplantation.
  
  
  METHODS
  We performed an institutional review board approved review of the living donor kidney transplantation database at our institution.
  
  
  RESULTS
  Seven of the 510 transplants (1%) were excluded from study due to immediate graft nephrectomy for vascular complications. Of the remaining 503 transplants 48 (9.5%) and 18 (3.6%) had slow and delayed graft function, respectively. Recipient male gender (OR 2.03, 95% CI 1.05-3.91, p = 0.035), black ethnicity (OR 1.59, 95% CI 1.08-2.34, p = 0.020) and donor age (OR 1.03, 95% CI 1.00-1.05, p = 0.021) emerged as independent predictors of poor early graft function in multivariate logistic regression models. Poor early graft function strongly redisposed patients to acute rejection during year 1 (HR 3.43, 95% CI 2.04-5.77, p <0.0001) while grafts from genetically related donors conferred a protective effect (HR 0.40, 95% CI 0.24-0.66, p <0.0001). Three-year death censored allograft survival was lower in the delayed and slow graft function groups than in the immediate function group (89% and 87% vs 98%, p = 0.0068 and 0.0002, respectively). Overall 3-year patient survival was lower in the delayed than in the immediate function group (81% vs 94%, p <0.0001).
  
  
  CONCLUSIONS
  Male black recipients of laparoscopically procured living donor kidney transplants from donors older than 50 years are at higher risk for poor early graft function, which in turn strongly predicts acute rejection during year 1. This is significant since excellent early graft function confers specific recipient and allograft survival advantages, and may assist physicians in better understanding the various recipient, donor and perioperative parameters that influence clinical outcomes.
authors: Dartmouth Medical School, Hanover, New Hampshire, USA. tyson.mark@mayo.edu
authors: Mark
authors: M
authors: Tyson
authors: Erik
authors: E
authors: Castle
authors: Paul
authors: P
authors: Andrews
authors: Raymond
authors: R
authors: Heilman
authors: Kristin
authors: K
authors: Mekeel
authors: Adyr
authors: A
authors: Moss
authors: David
authors: D
authors: Mulligan
authors: Kunam
authors: K
authors: Reddy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors