Early graft function after living donor kidney transplantation predicts rejection but not outcomes

被引:53
作者
Brennan, TV
Freise, CE
Fuller, TF
Bostrom, A
Tomlanovich, SJ
Feng, S [1 ]
机构
[1] Univ Calif San Francisco, Dept Surg, Div Transplantat, San Francisco, CA 94143 USA
[2] Charite, Dept Urol, Berlin, Germany
[3] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
关键词
acute rejection; delayed graft function; graft survival; living donor kidney transplantation; slow graft function;
D O I
10.1111/j.1600-6143.2004.00441.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Poor early graft function (EGF) after deceased donor kidney transplantation (DDKT) has been intensely studied. Much less is known about poor EGF after living donor kidney transplantation (LDKT). Data were collected on 469 LDKTs performed between 1/1/97 and 12/31/01 to determine risk factors for and outcomes associated with poor EGF, defined as either delayed or slow graft function (DGF or SGF). The incidence of DGF and SGF were 4.7% and 10.7%, respectively. Diabetic etiology (OR 2.22; p=0.021) and warm ischemia time (WIT) (OR 1.05 per min increment; p=0.0025) emerged as independently associated with poor EGF. Neither functional graft survival nor 1-year graft function differed among the EGF groups. However, DGF and SGF strongly predisposed to acute rejection (AR), which compromised functional graft survival (p=0.0007) and 1-year graft function. Therefore, we conclude that diabetic etiology of renal disease and WIT are the dominant risk factors for poor EGF after LDKT. Poor EGF did not directly compromise functional graft survival but strongly predisposed to AR. We suggest that immunosuppression should be intensified in the poor EGF setting to maximize LDKT longevity, as AR does impair functional graft survival.
引用
收藏
页码:971 / 979
页数:9
相关论文
共 22 条
[1]   LIVING-RELATED AND UNRELATED DONORS FOR KIDNEY-TRANSPLANTATION - A 28-YEAR EXPERIENCE [J].
DALESSANDRO, AM ;
SOLLINGER, HW ;
KNECHTLE, SJ ;
KALAYOGLU, M ;
KISKEN, WA ;
UEHLING, DT ;
MOON, TD ;
MESSING, EM ;
BRUSKEWITZ, RC ;
PIRSCH, JD ;
BELZER, FO .
ANNALS OF SURGERY, 1995, 222 (03) :353-364
[2]   Unrelated living donors in 141 kidney transplantations - A one-center study [J].
Foss, A ;
Leivestad, T ;
Brekke, IB ;
Fauchald, P ;
Bentdal, O ;
Lien, B ;
Pfeffer, P ;
Sodal, G ;
Albrechtsen, D ;
Soreide, O ;
Flatmark, A .
TRANSPLANTATION, 1998, 66 (01) :49-52
[3]   AJT 2001: the Genesis [J].
Halloran, PF .
AMERICAN JOURNAL OF TRANSPLANTATION, 2001, 1 (01) :1-3
[4]   Improved graft survival after renal transplantation in the United States, 1988 to 1996. [J].
Hariharan, S ;
Johnson, CP ;
Bresnahan, BA ;
Taranto, SE ;
McIntosh, MJ ;
Stablein, D .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (09) :605-612
[5]   Clinical determinants of multiple acute rejection episodes in kidney transplant recipients [J].
Humar, A ;
Payne, WD ;
Sutherland, DER ;
Matas, AJ .
TRANSPLANTATION, 2000, 69 (11) :2357-2360
[6]   Risk factors for slow graft function after kidney transplants: a multivariate analysis [J].
Humar, A ;
Ramcharan, T ;
Kandaswamy, R ;
Gillingham, K ;
Payne, WD ;
Matas, AJ .
CLINICAL TRANSPLANTATION, 2002, 16 (06) :425-429
[7]  
Humar A, 1997, CLIN TRANSPLANT, V11, P623
[8]  
JONES JW, 1994, TRANSPLANTATION, V57, P512
[9]   Living donors >55 years -: To use or not to use? [J].
Kerr, SR ;
Gillingham, KJ ;
Johnson, EM ;
Matas, AJ .
TRANSPLANTATION, 1999, 67 (07) :999-1004
[10]   Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection [J].
Kyllönen, LEJ ;
Salmela, KT ;
Eklund, BH ;
Halme, LEH ;
Höckerstedt, KAV ;
Isoniemi, HM ;
Mäkisalo, HJ ;
Ahonen, J .
TRANSPLANT INTERNATIONAL, 2000, 13 (02) :122-128