Creatinine reduction ratio on post-transplant day two as criterion in defining delayed graft function.

Delayed graft function (DGF) is a common complication after renal transplant, affecting its outcome. A common definition of DGF is the need for dialysis within the first week of transplantation, but this criterion has its drawbacks. We tried to validate an earlier and better defined parameter of DGF based on the creatinine reduction ratio on post-transplant day 2 (CRR2). We analyzed the clinical charts of 291 cadaver kidney recipients to compare the outcome of patients with immediate graft function (IGF), dialyzed patients (D-DGF) and nondialyzed CRR2-defined DGF patients (ND-DGF) and to identify risk factors for D-DGF and ND-DGF. Creatinine reduction ratio on post-transplant day 2 correlates significantly with renal function during the first year. Patients with IGF have significantly better renal function throughout the first year and better graft survival than patients with D-DGF and ND-DGF, while we found no differences either in renal function from days 30-365 or in graft survival between D-DGF and ND-DGF patients. Defining DGF by CRR2 allows an objective and quantitative diagnosis after transplantation and can help to improve post-transplant management. Creatinine reduction ratio on post-transplant day 2 correlates with renal function throughout the first year. The worse survival in the ND-DGF group is an important finding and a major advantage of the CRR2 criterion.

Acute rejection in the elderly recipient: influence of age in the outcome of kidney transplantation.

Since the immune response in older recipients is weaker they should be less likely to reject a transplanted organ and should need less aggressive immunosuppressive treatment. Our aim was to record the incidence and severity of episodes of acute rejection (AR), estimate the influence of these events on graft survival of elderly recipients (> or = 60) and to compare these with that in younger ones. We performed 363 kidney transplants between 1/94 and 12/98, and recorded clinical and immunological data, incidence-severity of AR and cause of graft loss. Patients were divided into two groups, according to the age at transplantation: A (<60, n = 281/77.4%) and B (> 60, n = 82/22.6%). The percentage of aging recipients and mean age of donors and recipients increased throughout the period. Although the incidence of ATN was higher in the older group (29% vs.19%, p < 0.0001) the number of graft biopsies was equal in both groups. The incidence of AR was similar, 33.4% vs. 26.8%, pNS. The number of AR episodes per patient was 0.44 and 0.41 respectively. The severity of AR was: Banff grade I: A (40.3%)/B (45.7%) pNS; grade II: A (44.1%)/B (48.57) pNS; grade III: A (15.5%)/B (5.7%) pNS. Younger recipients presented a higher level of panel-reactive antibodies (PRA) (4.3% vs. 2.07%, p = 0.01). One-yearpatient survival was 96%/91% (p < 0.05) and graft survival was 81%/78% (pNS) respectively. The age of recipient does not seem to have influenced the incidence-severity of AR or the graft survival. Thus immunosuppression should be individualized for each patient and should not depend on the age at transplantation.

Significance of age in the survival of diabetic patients after kidney transplantation.

BACKGROUND: In recent years acceptance of diabetic patients for renal replacement therapy has increased. Renal transplantation for Type I diabetic patients is widely accepted but the appropriate treatment for Type II diabetic patients is still a matter of dispute. Our study was done to determine whether the age of Type II diabetic patients constituted an additional risk factor. METHODS: We analyzed the outcome of renal transplantation in 56 diabetic patients, 31 Type I and 25 Type II diabetics (we excluded any who had combined kidney-pancreas transplants). We compared them with 51 non-diabetic patients who were transplanted because of end-stage renal failure due to nephrosclerosis and age-matched to type II diabetic patients. We assessed the one- and three-year patient and graft survival, the quality of renal function, the main complications and causes of mortality. RESULTS: The overall one- and three-year patient survival was 69% and 60% in Type II patients; 73% and 69% in Type I diabetes patients and 88% and 80% in patients with nephrosclerosis. The overall one- and three-year actuarial graft survival was 50% and 38% in patients with Type II disease and 58% and 50% in Type I diabetes, and 76% and 64% in nephrosclerosis. The main cause of graft loss in all groups was death (with functioning kidney) due to infections and cardiovascular complications. CONCLUSIONS: Diabetes itself is the most important variable in patients who have poor results after kidney transplantation. Increasing age increases slightly the risk for poor graft and patient survival. Both groups of diabetic patients have poorer results than controls but in this comparison age was an independent factor.

The risk of cardiovascular disease associated with proteinuria in renal transplant patients.

Proteinuria in the general population has been shown to be associated with cardiovascular disease, which is the main cause of death in renal transplantation. We investigated the effect of proteinuria on cardiovascular disease after renal transplantation in 532 renal transplant patients with functioning grafts for more than 1 year. Patients were classified into two groups depending on the presence of persistent proteinuria. We analyzed graft and patient survival, posttransplantation cardiovascular disease, and main causes of graft loss and death. Five- and 10-year graft and patient survival rates were lower in the group with proteinuria. The main cause of death was vascular disease in both groups. The presence of posttransplantation cardiovascular disease was higher in the group with proteinuria. Persistent proteinuria was associated with graft loss (RR=4.18), patient death (RR=1.92), and cardiovascular disease (RR=2.45). In conclusion, persistent proteinuria was an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant patients.