POS-770 “SLOW AND STEADY MAY NOT ALWAY WIN THE RACE “ –SHORT TERM OUTCOMES OF SLOW GRAFT FUNCTION POST RENAL TRANSPLANT - A SINGLE CENTRE EXPERIENCE

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It is well established that delayed graft function (DGF), traditionally defined as the requirement of dialysis within the first week of transplant, is associated with poorer graft outcomes as compared to immediate graft function (IGF). A subset of patients do not have immediate graft function, but rather have a slower decrease in serum creatinine, not requiring dialysis, termed as slow graft function. Outcomes of this group of patients have not often been studied and most studies have classified this group of patients as having Immediate graft function (IGF) for comparison with patients with DGF. Our aim was to assess short term outcomes of these patients with slow graft function and to identify risk factors, if any among the cohort. Study setting: Kasturba Medical College, Manipal, a tertiary care centre in South India providing healthcare services to a predominantly rural population Type of study: Retrospective, ObservationalStudy Period: January 2016 to April 2018 Sample Size: 70 Renal allograft recipients Slow graft function was defined as per previous studies as follows 1)Creatinine > 3 mg/dl at Post-op day 5 or > 2.5mg/dl at day 72)Creatinine >1.5 and creatinine reduction ratio (CRR) < 20% between Post-op day 1 and post-op day 3Patients with DGF were not included in this study. Demographics related to recipient and donor, biopsy-proven acute rejections, short term outcomes in terms of graft function(serum creatinine and eGFR) at 1 year and 2 years follow up were documented and analysed. The transplants were predominantly living donor ( 88.6% ) and ABO compatible ( 97.1%) with a median follow up of 30 months (IQR 25-40) . 27 out of 70 transplanted patients (38.6%) were characterized as having slow graft function (SGF) as per the definitions and criteria used from earlier studies (Table 1: Baseline characteristics) . On univariate analysis, patients with SGF had lower GFR at 1 year (p-value – 0.028), higher number of biopsy-proven acute rejections over the median follow up period ( 48.1% versus 25.5 %; p-value – 0.039). The number of transplant patients with graft dysfunction at 1 year ( eGFR <60 ml/min) and 2 years were also statistically significant (Table 2: Univariate Analysis). Donor age and donor GFR ( measured by DTPA) were not significantly associated with SGF though numerically median donor age was higher and donor GFR was lower. The subset of patients with SGF may have adverse short term outcomes as compared to those with immediate graft function. A higher incidence of biopsy-proven rejection and higher number of patients with graft dysfunction at 2 years was seen in this cohort. Long term outcomes assessment and identification of risk factors leading to SGF needs to be studied and may help to better risk stratify and manage these patients for better outcomes.