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NDT Advance Access originally published online on September 25, 2006
Nephrology Dialysis Transplantation 2007 22(1):235-245; doi:10.1093/ndt/gfl530
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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

Peter Schnuelle1, Uwe Gottmann1, Hannes Köppel1, Paul Thomas Brinkkoetter1, Stefan Krzossok1, Johannes Weiss2, Wilhelm Schmitt1, Benito A. Yard1, Matthias Heinrich Martin Schwarzbach2, Stefan Post2, Fokko Johannes van der Woude1 and Rainer Birck1

1Vth Medical Clinic and 2Clinic of Surgery, University Hospital Mannheim, Medical Faculty of the University of Heidelberg, Theodor Kutzer Ufer 1-3, D-69135 Mannheim, Germany

Correspondence and offprint requests to: Peter Schnuelle, MD, University Hospital Mannheim, Vth Medical Clinic, Theodor-Kutzer Ufer 1-3, 68135 Mannheim, Germany.Email: peter.schnuelle{at}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.

Keywords: delayed graft function; graft survival; kidney transplantation; serum creatinine; urine output post-transplant


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