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Related Experiment Videos

Risk factors for slow graft function after kidney transplants: a multivariate analysis.

A Humar1, T Ramcharan, R Kandaswamy

  • 1Department of Surgery, University of Minnesota, Minneapolis, 55455, USA. humar001@umn.edu

Clinical Transplantation
|November 20, 2002
PubMed
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Slow graft function (SGF) in kidney transplants, defined by creatinine levels above 3 mg/dL on post-operative day 5 without dialysis, is linked to increased rejection and lower graft survival. Donor age over 50 and preservation time over 24 hours are key risk factors for SGF.

Area of Science:

  • Nephrology and Transplant Surgery
  • Immunology of Transplantation
  • Clinical Outcomes Research

Background:

  • Defined an intermediate group of cadaver kidney transplant recipients with slow graft function (SGF), distinct from immediate graft function (IGF) and delayed graft function (DGF).
  • Previous work indicated SGF recipients face increased rejection risk and poorer long-term outcomes compared to IGF recipients.
  • Risk factors for SGF remain less defined than those for DGF.

Purpose of the Study:

  • To identify and define the specific risk factors associated with slow graft function (SGF) in adult cadaver kidney transplant recipients.
  • To compare the risk factors for SGF with those identified for delayed graft function (DGF).
  • To analyze the impact of initial graft function (IGF, SGF, DGF) on subsequent acute rejection rates and long-term graft survival.

Related Experiment Videos

Main Methods:

  • Retrospective analysis of 896 adult cadaver kidney transplants performed between 1984 and 1999.
  • Recipients categorized into IGF, SGF, or DGF based on post-operative day 5 creatinine levels and need for dialysis.
  • Multivariate analysis employed to determine risk factors for SGF and DGF, and to compare graft survival and acute rejection rates across the three groups.

Main Results:

  • Significant risk factors for SGF included donor age over 50 years (RR=3.3) and kidney preservation time exceeding 24 hours (RR=1.6).
  • Risk factors for DGF were similar but also included high panel-reactive antibodies (PRA) and donor creatinine >1.7 mg/dL.
  • Incidence of acute rejection at 12 months was higher in SGF (38%) and DGF (44%) groups compared to IGF (28%). Five-year death-censored graft survival was 72% for SGF and 67% for DGF, versus 89% for IGF.

Conclusions:

  • Slow graft function (SGF) is a recognized part of the post-transplant graft dysfunction spectrum.
  • Identified risk factors for SGF largely overlap with those for DGF, highlighting shared mechanisms of early graft injury.
  • Even mild to moderate post-transplant graft dysfunction, such as SGF, significantly impairs long-term graft survival and increases rejection risk.