Pre-transplant calcium-phosphate-parathormone homeostasis as a risk factor for early graft dysfunction

While good organ quality and ideal transplant conditions eliminate many of the know factors that compromise initial graft function (IGF), poor early graft function (EGF) still occurs after living donor kidney transplantation (LDKT). Uncontrolled pre-transplant hypercalcemia and hyperparathyroidism are associated with impaired allograft function. Between April 2004 and January 2006, data were collected on 354 LDKT recipients including 252 males and 102 females, to determine risk factors for poor EGF, defined as either delayed or slow graft function (DGF or SGF). Of the 354 recipients, 318 (89%) had IGF, 22 (6.2%) had SGF and 14 (4%) had DGF. Donor female gender (P = 0.04) and duration on dialysis (P = 0.02) were associated with poor EGF. Recipients with DGF had higher serum phosphate (P = 0.07) and calcium x phosphate product ( P = 0.01) than recipients with IGF and SGF. The serum parathormone (PTH) levels were higher in recipients with SGF and DGF although the difference was not statistically significant (P = 0.1). Serum calcium levels did not correlate with the occurrence of poor EGF (P = 0.9). Our study suggests that serum phosphate and calcium x phosphate product serve as risk factors for DGF while serum PTH level may play a role as a risk factor for SGF and DGF.