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. 2018 Apr 3:23:224-231.
doi: 10.12659/AOT.907397.

Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients

Connie J Wang  1 , Ahmad Tuffaha  2   3 , Milind A Phadnis  4 , Jonathan D Mahnken  4 , James B Wetmore  1   5
Affiliations

Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients

Connie J Wang et al. Ann Transplant. .

Abstract

BACKGROUND Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown. MATERIAL AND METHODS In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival. RESULTS Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02-2.10 for SGF and HR 1.56, CI 1.11-2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05-2.20 for SGF and HR 1.54, CI 1.10-2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36-0.80 for SGF in Schema 1; HR 0.58, CI 0.39-0.85 for SGF in Schema 2). CONCLUSIONS These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.

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Conflict of interest statement

Conflicts of interests

None.

Figures

Figure 1
Figure 1
Distribution of DGF, SGF, and IGF.
Figure 2
Figure 2
Death censored graft failure. (A) Graft survival with Schema 1. (B) Graft survival with Schema 2.
Figure 3
Figure 3
All-cause patient mortality. (A) Patient survival with Schema 1. (B) Patient survival with Schema 2.
Figure 4
Figure 4
Five-year eGFR distribution. (A) 5-year eGFR distribution with Schema 1. (B) Five-year eGFR distribution with Schema 2.
See this image and copyright information in PMC

References

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