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Nephrol Dial Transplant. 2007 Jan;22(1):235-45. Epub 2006 Sep 25.

Comparison of early renal function parameters for the prediction of 5-year graft survival after kidney transplantation.

Author information

1
University Hospital Mannheim, Vth Medical Clinic, Theodor-Kutzer Ufer 1-3, 68135 Mannheim, Germany. peter.schnuelle@med5.ma.uni-heidelberg.de

Abstract

BACKGROUND:

Early graft function (EGF) has an enduring effect on the subsequent course after kidney transplantation. This study compares quantitative parameters of EGF for the prediction of graft survival.

METHODS:

We involved 300 consecutive transplant recipients from deceased donors from 1989 to 2005. Urine output during 24 h post-transplant (UO), and serum creatinine after 1 week (Cr7) were taken for explanatory variables. We generated Kaplan-Meier (K-M) estimates of graft survival, by quintiles of the explanatory variable. Cox regression was applied to control for various recipient factors.

RESULTS:

K-M survival estimates indicate a threshold effect of UO and Cr7, which can dissect the risk of graft failure. The thresholds referring to the 2nd quintile correspond to a UO >630 ml and a Cr7 <2.5 mg/dl and were associated with a proportional hazard ratio of 0.52 (95% CI 0.33-0.84) and 0.34 (95% CI 0.18-0.65), respectively. Combining both of the parameters predicted a 5-year graft survival probability >90%, according to a hazard ratio of 0.21 (95% CI 0.09-0.46). Requirement of dialysis post-transplant lost its discriminatory power and was not a significant explanatory variable in the multivariate analysis.

CONCLUSION:

Routine parameters for monitoring of EGF display a threshold effect allowing accurate prediction of 5-year graft survival at the earliest point in time. The quantitative threshold levels for an optimum discriminatory power require validation in a larger, preferably multicentre database.

PMID:
17000734
DOI:
10.1093/ndt/gfl530
[Indexed for MEDLINE]

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