P1632IMPACT OF RENAL TRANSPLANTATION ON THE FUNCTIONAL STATUS OF PATIENTS WITH END-STAGE RENAL FAILURE IN TACROLIMUS ERA

Abstract

Abstract Background and Aims Survival after renal transplantation has improved significantly over the past 20 years. On the contrary, surprisingly little is known about the functional status post-transplant. A fundamental understanding of the functional status of patients surviving renal transplantation is of primary importance to clinicians and families alike, who often pursue renal transplantation with a principal hope that functional status will improve. The aim of our study is to assess the effect of renal transplantation on functional status of the patients in tacrolimus era Method Using data from the United States organ procurement and transplantation network, all renal transplant patients maintained on tacrolimus-based immunotherapy and had functional assessment at time of transplant and five-years post-transplant were retrospectively reviewed. Data including age, sex, gender, ethnicity, functional status, diabetes, body mass index, cold ischemia time, number of previous transplants, panel reactive antibodies, donor type, donor age, HLA-mismatches, number of acute rejection episodes, induction therapies, maintenance immunotherapy on discharge were collected. Functional status was defined according to Karnofsky score measurements. Descriptive analysis was used to assess effect of renal transplantation on functional status. Outcome measured was functional status five-years post-transplant. Multiple logistic regression analysis was used to assess factors affecting functional status post-transplant. Results 19704 patients were included in the study. Among patients with mild impairment at time of transplant, only 13.55% showed worsening of functional status. Among patients with moderate impairment at time of transplant, 65.5% showed improvement of functional status while only 3.92% showed worsening of functional status. Among patients with severe impairment at time of transplant, 88.56% showed improvement in functional status (64.57% showed improvement to mild impairment and 23.99% showed improvement to moderate impairment). Multiple logistic regression analysis showed that steroid withdrawal protocol is associated with improvement in functional status (OR=1.24, P=0.007, CI ranges from 1.06 to 1.45), while dialysis maintenance before transplantation was associated with abnormal functional status post-transplant (OR=0.73, P=0.003, CI ranges from 0.59 to 0.89). Conclusion This study revealed that renal transplantation is associated with substantial improvement in functional status of the patients. Steroid withdrawal protocols is associated with significant improvement in functional status while maintenance dialysis before transplantation is associated with worse outcomes. This study recommends using steroid withdrawal protocols and performing transplantation for the patients at the pre-dialysis state. Functional status at time of transplant shouldn’t be a hindrance to performing transplantation.