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03 April 2018 : Original article  

Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients

Connie J. Wang1ABCDEF*, Ahmad Tuffaha23BDEG, Milind A. Phadnis4CDEF, Jonathan D. Mahnken4ACDF, James B. Wetmore15ACDEF

DOI: 10.12659/AOT.907397

Ann Transplant 2018; 23:224-231

Abstract

BACKGROUND: Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown.

MATERIAL AND METHODS: In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival.

RESULTS: Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02–2.10 for SGF and HR 1.56, CI 1.11–2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05–2.20 for SGF and HR 1.54, CI 1.10–2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36–0.80 for SGF in Schema 1; HR 0.58, CI 0.39–0.85 for SGF in Schema 2).

CONCLUSIONS: These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.

Keywords: Delayed Graft Function, Graft Survival, Kidney Transplantation, Mortality

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358