Influence of selected factors on long-term kidney graft survival--a multivariable analysis.
BACKGROUND
Long-term function of transplanted kidney is the factor determining quality of life for transplant recipients. The aim of this study was to evaluate the effect of selected factors on time of graft function after renal transplantation within 15 years of observation.


METHODS
Preoperative and intraoperative factors were analyzed in 232 kidney recipients within a 15-year observation period. Analysis included age, sex, cause of recipient's renal failure, length of hemodialyses before transplantation, peak panel reactive antibodies test, human leukocyte antigen compatibility, cold ischemia time, delayed graft function occurrence, length and time of hemodialyses after transplantation, early graft rejection, creatinine level at days 1, 3, 7, 30, 90, and 180 after transplantation, and influence of these factors on the time of graft function. Statistical analysis was performed with the use of univariate and multivariate Kaplan-Meier test and Cox regression proportional hazards model, with P < .05 considered to be significant.


RESULTS
Univariate analysis showed significantly shorter renal graft function in the group of recipients with higher creatinine levels in all of the analyzed time periods and in patients experiencing delayed graft function. Length of time of hemodialyses after transplantation and number of dialyses had significant impact on worsening of late transplant results. Multivariate analysis reported that early graft rejection in the postoperative period is an independent factor improving late graft function: P = .002; hazard ratio (HR), 0.49 (95% confidence interval [CI], 0.31-0.78). Higher creatinine level at day 90 after kidney transplantation is a predictive factor of late graft dysfunction: P = .002; HR, 1.68 (95% CI 1.2-2.35).


CONCLUSIONS
Creatinine level at day 90 after renal transplantation is the prognostic factor of long-term kidney function. Early transplant rejection leads to introduction of more aggressive immunosuppression protocol, which improves long-term transplant results.
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland. Electronic address: zukowski@sci.pam.szczecin.pl.
M
M
Zukowski
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
K
K
Kotfis
Department of Laboratory Diagnostic and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland.
M
M
Kaczmarczyk
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
J
J
Biernawska
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
L
L
Szydłowski
Clinical Microbiology, Teaching Hospital No 2, Pomeranian Medical University, Szczecin, Poland.
A
A
Zukowska
Clinic of General and Transplant Surgery, Pomeranian Medical University, Szczecin, Poland.
T
T
Sulikowski
Clinic of General and Transplant Surgery, Pomeranian Medical University, Szczecin, Poland.
A
A
Sierocka
Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
R
R
Bohatyrewicz
D000328:Adult; D064591:Allografts / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D051799:Delayed Graft Function / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D003404:Creatinine