DURATION OF DELAYED GRAFT FUNCTION PREDICTS ONE YEAR CREATININE IN CHILEAN KIDNEY TRANSPLANT RECIPIENTS

Abstract

A121 Aim: One year Serum Creatinine (S Cr) has been used as a surrogate marker for graft survival in kidney transplantation. The purpose of this study is to evaluate the importance of different factors on one year S Cr in a single centre experience in kidney transplantation emphasizing the importance of adequate exposure to Cyclosporine (CyA) on one year S Cr. Methods: Ninety –six consecutive renal transplants performed between 1996 and 2002 with at least one year follow-up were included. Mean age at transplantation was 39 ± 12, 52% were female, 16% living donors, all received triple immunosuppression with CyA, steroids and Azathioprine. Univariate and Multivariate regression analysis were performed for one year S Cr, Acute Rejection (AR) and duration of Delayed Graft Function (DGF). Factors considered for analysis were: donr and recipient age and sex, number of transplants, Panel Reactive Antibodies, Total number of HLA mismatches (MM), Cold Ischemia Time (CIT), presence and duration of DGF, AR, and ability to achieve adequate CyA levels by one week (>250ng/ml trough levels (38%) or three hour post dose level (C3) >1100ng/ml (62%)).All calculations were performed on the Stat View® software. Results: Mean one year S Cr was 1.52 ± 0.5, AR rate within one year was 27% and DGF rate was 31% with a mean duration of 5 ± 9 days (range 0-31). Only 53% of patients achieved adequate exposure to CyA at one week (68% for C3). Univariate analysis identified female recipient sex, decreasing donor age, absence of AR, absence of DGF, and decreasing DGF duration as giving lower one year S Cr (p <0.05). Multivariate analysis left donor age (lower), AR rate and duration of DGF(shorter) as significant in yielding lower one year S Cr. Multivariate analysis of AR showed that ability to achieve adequate CyA exposure and lower MM to protect from AR and ability to achieve adequate exposure to CyA and shorter CIT to protect from DGF Conclusions: One year S Cr is affected primarily by the incidence of AR, donor age and duration of DGF. The ability to achieve adequate CyA exposure significantly improves both AR rate and DGF. Every effort should be made to improve CyA exposure to improve one year S Cr and possibly graft survival.