Am J Transplant. 2005 Sep;5(9):2253-7. Comment in: Nat Clin Pract Nephrol. 2006 Apr;2(4):190-1.

Department of Medicine, Division of Nephrology, University of Iowa School of Medicine, Iowa City 52242, Iowa, USA.
roberto-kalil@uiowa.edu

A simplified model to correlate early allograft function with long-term allograft survival in recipients of deceased donor renal transplants (DDRT) remains challenging. We propose here a novel approach, using the change from the pretransplant creatinine to the 30-day posttransplant creatinine. The outcomes of 153 consecutive DDRT performed at our center between January 1998 and March 2001 were reviewed. The percentage change in creatinine from the pretransplant to 1 month posttransplant, termed here, the creatinine reduction ratio (CRR), was calculated as follows: (pretransplant creatinine-creatinine at 1 month)/pretransplant creatinine *100%. Patients were divided as follows: group 1 CRR≥67% and group 2<67%. Group 1 had a graft survival at 1 and 5 years of 100% and 89.1% versus 88% and 69.1% for group 2 (log-rank p=0.0008). The risk ratio for graft loss during the follow-up period was four times lower for the patients on group 1. Using the Cox hazards model to compare CRR≥67% with determinants of long-term outcome, the risk ratio of graft loss during the observational period was 0.26 (p=0.001). The creatinine reduction ratio, when stratified by a level of ≥67% has a strong correlation with superior long-term allograft survival in recipients of DDRT.