Using creatinine reduction ratio as a predictor for delayed graft function of kindey transplant recipients from donor of cardiac death

Abstract

Objective: To explore the relationship between creatinine reduction ratio (CRR) and delayed graft function among kidney transplant recipients from donor of cardiac death (DCD). To define the value of CRR to predict delayed graft function (DGF) in early post-transplant period. Method: 86 patients were included, who received renal transplantation from DCD during Jan 1(st) 2011 to Jun 30(th) 2016. We performed a retrospective study and collected creatinine data within 3 days post-operation and marked them with Cr1, Cr2 , Cr3, and then calculated creatinine reduction ratio day-2 (CRR 2) =(Cr1-Cr2)/Cr1×100% and creatinine reduction ratio day-3 (CRR 3)=[(Cr1-Cr2)/Cr1+ (Cr2-Cr3)/Cr2]/2×100%. Patients were divided into two groups by DGF or not. We compared the CRR differenc between DGF group and no DGF group, and drew the receiver operating characteristic curve (ROC curve) to find out the cut-off value to predict delayed graft function. Results: Among 86 patients, DGF appeared in 17 patients. The incidence of DGF was 19.8%. The CRR 2 of patients in no DGF group was (37.5±17.4)% while patients in DGF group was (2.0±24.8)% (P<0.001). The CRR 3 of patients in no DGF group was (32.5±13.1)%, while patients in DGF group was (6.8±17.1)% (P<0.001). Acorrding to ROC curve, when cut-off value of CRR 2 was defined as <20.7%, the predicted value of DGF was the best, sensitivity was 85.5%, specificity was 76.5%, and area under the curve was 0.876. In the same way, when CRR 3 was defined as <17.6%, sensitivity was 89.9%, specificity was 76.5%, area under the curve was 0.872. Conclusion: It is reliable to predict DGF by CRR during early post-operative period. CRR shows high sensitivity and specificity and it is simple. It could guide the adjustion of immunosuppressive regimen, prevent early rejection and improve prognosis.