Evolution of the renal function is a better predictor of long-term survival than serum creatinine.

BACKGROUND: In recent years acute rejection has decreased to 10% to 20%. Therefore it is necessary to look for new endpoints in renal transplantation. Serum creatinine and changes in creatinine have been reported to be powerful predictors of long-term kidney transplant survival. Chronic renal allograft nephropathy is the primary cause of long-term graft failure but may appear at any stage in the evolution. METHODS: Data from 315 patients receiving cadaver donor renal transplants between February 1987 and March 2001 that functioned for 1 year were examined for the influence of demographic characteristics and transplant variables. Creatinine clearance was estimated using the Cockroft-Gault formula. Survival was assessed with the actuarial method. The multivariate analyses were performed using Cox proportional hazard models. RESULTS: The 10-year graft survival showed a relative risk of 2.5 in the univariate analysis when there was more than 10% decrease in renal function at 3 months compared with nadir values. When the decrease was more than 25% of creatinine clearance at the third month, during the evolution and serum creatinine at 3 months introduced in the multivariate model, the latter was not significant, while the other variables had a RR of 4.4 and 10, respectively. CONCLUSION: The evolution of renal function at 3 months and throughout the evolution were better predictors of graft failure than an isolated serum creatinine value.

Changes in renal transplantation: comparison between two different series.

BACKGROUND: New immunosuppressives have improved the results of renal transplants. However, the features of donors and recipients have changed, producing an increased age in both cases and more donors dying from strokes. We analyzed the impact of donor and recipient profile on survival of graft in recipients treated with new immunosuppressive agents. METHODS: Data from 343 patients receiving cadaveric renal transplants functioning for 1 year on February of 1987 and March of 2001 when cyclosporine was incorporated in the immunosuppressive regimen. Two series were distinguished from the point of view of immunosuppression: an historical series and a current series. Graft survival rates were analyzed using the actuarial method. Multivariate analysis was achieved with Cox proportional hazards model. RESULTS: Actuarial survival at 5 years was lower in the current series, 77%, as opposed to 82% in the historic series. Donor and recipient age, proteinuria, and losses in immediate postoperative period were significantly higher in the current series. However, acute rejection episode dropped from 54% to 21%. Delayed graft function also decreased from 18% to 10% in the current series. When multivariate analysis was performed of grafts functioning at 1 year, the relative risk was 3.12 in the historical series adjusted for other variables. CONCLUSION: The data suggested that new immunosuppressive regimens counteract suboptimal features for donors and recipients.