Dialysis – Transplantation
Kidney International (2002) 62, 311–318; doi:10.1046/j.1523-1755.2002.00424.x
Post-transplant renal function in the first year predicts long-term kidney transplant survival
Sundaram Hariharan, Maureen A Mcbride, Wida S Cherikh, Christine B Tolleris, Barbara A Bresnahan and Christopher P Johnson
Departments of Medicine and Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, and United Network for Organ Sharing, Richmond, Virginia, USA
Correspondence: Sundaram Hariharan, M.D., Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. E-mail: hari@mcw.edu
Received 26 November 2001; Revised 19 February 2002; Accepted 21 February 2002.
Abstract
Post-transplant renal function in the first year predicts long-term kidney transplant survival.
Background
Improvements in long-term kidney graft survival have been recently noted. However, the reasons for this were unclear. This study examined post-transplant renal function within the first year as an independent variable influencing long-term survival.
Methods
The influence of demographic characteristics (age, sex, race); transplant variables (cadaver versus living donor, cold ischemia time, HLA mismatching, delayed graft function and transplant year), and post-transplant variables (immunosuppressive agents for the prevention of acute rejection, clinical acute rejection and post-transplant renal function in the first year) on graft survival were analyzed for 105,742 adult renal transplants between 1988 and 1998. Renal function in the first year was expressed as serum creatinine at six months and one year and delta creatinine (change in serum creatinine between 6 months and 1 year). Graft half-life was used to measure long-term survival.
Results
During this 11-year period, the one-year serum creatinine values for cadaver recipients steadily improved, from 1.82 
0.82 mg/dL in 1988 to 1.67 0.82 mg/dL in 1998 (P < 0.001), as did the graft half-life. There was a progressive decline in graft half-life for each incremental increase of six month, one year and 
creatinine for living and cadaver donor transplants as well for cadaver transplants with donor age> and 
50 years. The Relative Hazard (RH) for graft failure was 1.63 (1.61, 1.65; P < 0.0001) with each increment of 1.0 mg/dL of serum creatinine at one year post-transplant and it increased to 2.26 (2.2, 2.31; P < 0.0001) when the creatinine was 0.5 mg/dL. The RH reduction for graft failure was substantially lower for the years 1993, 1996, 1997 and 1998 when post-transplant renal function was not included in the model (P < 0.05). However, the RH reduction per year was not different when post-transplant creatinine was included in the model, 1.01 (0.94 to 1.05; P = 0.89).
Conclusion
In conclusion, one-year creatinine and creatinine values predict long-term renal graft survival. Recent improvements in graft half-life are related to conservation of renal function within the first year post-transplantation.
Keywords:
serum creatinine, graft survival, renal transplant, cadaveric grafts, living donor grafts
