TY - JOUR
T1 - Risk factors for rising creatinine in renal allografts with 1 and 3 yr survival
AU - Paraskevas, Steven
AU - Kandaswamy, Raja
AU - Humar, Abhinav
AU - Gillingham, Kristen J.
AU - Gruessner, Rainer W.
AU - Payne, William D.
AU - Najarian, John S.
AU - Sutherland, David E.R.
AU - Matas, Arthur J.
PY - 2006/11
Y1 - 2006/11
N2 - Background: Determining factors associated with negative slope of inverse creatinine vs. time (1/Cr vs. t) may help prevent a decline in renal allograft function. Methods: A total of 1389 adult recipients of primary renal transplants were divided into quartiles based on the slope of 1/Cr vs. t calculated from 6 and 12 months post transplant. A multivariate analysis of risk factors for being in the worst vs. best quartile employed these variables: donor source, HLA mismatch, recipient age, donor age, panel-reactive antibody (PRA), acute rejection (AR), 3-month cyclosporin A (CsA) level, 1-yr CsA level and acute tubular necrosis. Two separate analyses compared risk factors in patients with 1 and 3 yr survival, respectively. Results: In recipients with ≥1 yr graft survival, highPRA and AR were associated with negative slopes of 1/Cr vs. t. For those with ≥3 yr graft survival, both AR and 3-month CsA level >150 ng/mL were significant risk factors, using both 6- and 12-month slopes. Stratification of AR showed 1 AR episode ≥6 months and multiple AR episodes carried significant risk for negative slopes. Conclusion: Optimization of allograft function invokes a conundrum between the needs to avoid both AR and high early CsA levels. We support a policy of carefully balancing these two risks.
AB - Background: Determining factors associated with negative slope of inverse creatinine vs. time (1/Cr vs. t) may help prevent a decline in renal allograft function. Methods: A total of 1389 adult recipients of primary renal transplants were divided into quartiles based on the slope of 1/Cr vs. t calculated from 6 and 12 months post transplant. A multivariate analysis of risk factors for being in the worst vs. best quartile employed these variables: donor source, HLA mismatch, recipient age, donor age, panel-reactive antibody (PRA), acute rejection (AR), 3-month cyclosporin A (CsA) level, 1-yr CsA level and acute tubular necrosis. Two separate analyses compared risk factors in patients with 1 and 3 yr survival, respectively. Results: In recipients with ≥1 yr graft survival, highPRA and AR were associated with negative slopes of 1/Cr vs. t. For those with ≥3 yr graft survival, both AR and 3-month CsA level >150 ng/mL were significant risk factors, using both 6- and 12-month slopes. Stratification of AR showed 1 AR episode ≥6 months and multiple AR episodes carried significant risk for negative slopes. Conclusion: Optimization of allograft function invokes a conundrum between the needs to avoid both AR and high early CsA levels. We support a policy of carefully balancing these two risks.
KW - Calcineurin inhibitors
KW - Creatinine
KW - Kidney
KW - Outcomes
KW - Slope
UR - http://www.scopus.com/inward/record.url?scp=33750801134&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33750801134&partnerID=8YFLogxK
U2 - 10.1111/j.1399-0012.2006.00566.x
DO - 10.1111/j.1399-0012.2006.00566.x
M3 - Review article
C2 - 17100713
AN - SCOPUS:33750801134
SN - 0902-0063
VL - 20
SP - 667
EP - 672
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 6
ER -