Renal Function at Six Months Is the Most Relevant Risk Factor for Graft Failure at Seven Years after Renal Transplantation

Abstract

Introduction: To describe the results of renal transplantation in the clinical practice at seven years with special emphasis on risk factors for graft loss and mortality in Spain. Methods: From a database focus on postransplant cardiovascular disease (CDV) we prospectively analyzed the results at seven years of all transplanted patients: 2600 (without exclusions) during 2000-2002 in 14 Spanish units. Results: Donors and recipient age were 46.9±17 and 49.7±13.7 years, 16% were retransplanted and 12.5% hyperimmunized. The most frequent immunosuppressive protocol was Tac+MMF+St.(65%) and acute rejection rate at 1 year was 14.8%. At 7 years patients survival was 85.% and graft survival censored and non-censored death was 78.% and 70 % respectively. The main causes of death were CDV 32.5%, (especially coronary disease) 21% infections and 15 neoplasia. As expected, chronic allograft nephropathy (3.5%) and death with function (27%) were the most important causes of graft loss. Renal function at 7yr (1528 patients) showed SCr was 1.56 ± 0.8 mg/dl and MDRD 53.3ml/min. Interestingly, most of them maintained good renal function: 51% and 30% were on stages II and III of renal disease with the same immunosuppressive protocol (St+TAC+MMF). In the multivariatye analysis, (in patients surviving more than 6 mo.) the most striking finding was that renal function at 6mo. (SCr more than 1.5 mg/ dl) was the most powerful risk factor for graft loss and the second one risk factor for patient death (after pretransplant CDV disease). Conclusion: Our results suggest that in the clinical practice early renal function, SCr more than 1.5 mg/dl at six months, is the most important predictor of graft survival and the second for patient death in the mediumterm after renal transplantation. Measures to early ameliorate renal function could contribute to improve survival figures.