title: Early renal function recovery and long-term graft survival in kidney transplantation.
abstract: Following kidney transplantation (KTx), renal function improves gradually until a baseline eGFR is achieved. Whether or not a recipient achieves the best-predicted eGFR after KTx may have important implications for immediate patient management, as well as for long-term graft survival. The aim of this cohort study was to calculate the renal function recovery (RFR) based on recipient and donor eGFR and to evaluate the association between RFR and long-term death-censored graft failure (DCGF). We studied 790 KTx recipients between January 1990 and August 2014. The last donor SCr prior to organ procurement was used to estimate donor GFR. Recipient eGFR was calculated using the average of the best three SCr values observed during the first 3 months post-KTx. RFR was defined as the ratio of recipient eGFR to half the donor eGFR. 53% of recipients had an RFR ≥1. There were 127 death-censored graft failures (16%). Recipients with an RFR ≥1 had less DCGF compared with those with an RFR <1 (HR 0.56; 95% CI 0.37-0.85; P = 0.006). Transplant era, acute rejection, ECD and DGF were also significant determinants of graft failure. Early recovery of predicted eGFR based on donor eGFR is associated with less DCGF after KTx.
authors.affiliation: Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Wan
authors.affiliation: Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
authors.affiliation: Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.|Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.affiliation: Division of Nephrology, Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Dana
authors.initials: D
authors.lastname: Baran
authors.affiliation: Division of General Surgery, Department of Surgery, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.affiliation: Division of General Surgery, Department of Surgery, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
keywords: estimated glomerular filtration rate; graft survival; renal function; renal function recovery; serum creatinine