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
Summary
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.
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.