2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by PROMMOOL, S. Articles by HALLORAN, P. F. Search for Related Content PubMed PubMed Citation Articles by PROMMOOL, S. Articles by HALLORAN, P. F.

Time Dependency of Factors Affecting Renal Allograft Survival

SURAZEE PROMMOOL^*, GIAN S. JHANGRI, SANDRA M. COCKFIELD^* and PHILIP F. HALLORAN^*

^* Department of Medicine (Division of Nephrology), University of Alberta, Edmonton, Alberta, Canada.
Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.

Correspondence to Dr. Philip F. Halloran, Division of Nephrology and Immunology, #303, 8249-114 Street, Edmonton, Alberta, Canada T6G 2R8. Phone: 780-407-8880; Fax: 780-431-0461; E-mail: phil.halloran{at}ualberta.ca

Abstract. The function of renal transplants can deteriorate at any time posttransplant, but the risks and mechanisms may differ at different times posttransplant. Survival of 522 consecutive cadaveric renal transplant recipients followed for at least 6 mo were analyzed, with patient death censored. The overall risk factors in univariate analysis were acute rejection requiring antibody therapy (AR), delayed graft function, elevated serum creatinine at 6 mo, high panel-reactive antibodies, and donor age 55 yr, with borderline effects of recipient age and female gender. These risks were studied in each of three intervals posttransplantation: 6 mo, 6 mo to 5 yr, and >5 yr. Of the 135 graft failures, 53 occurred 6 mo, 61 between 6 mo and 5 yr, and 21 beyond 5 yr. By multivariate analysis, the risks for graft failure in interval 6 mo were AR (hazard ratio (HR) = 4.86, P < 0.001); delayed graft function (HR = 1.47, P = 0.06); and high panel-reactive antibodies (HR = 2.04, P = 0.03). Between 6 mo and 5 yr, the risks for graft loss were AR (HR = 2.87, P < 0.001) and serum creatinine at 6 mo 150 µmol/L (HR = 3.69, P < 0.001). Beyond 5 yr the risk factors were donor age 55 yr (HR = 5.87, P = 0.002), with a borderline effect of kidneys from female donors (HR = 2.28, P = 0.07). HLA-A, -B, and -DR matching and presensitization had most of their effect through early AR and impaired function. The results indicate that risks for graft loss are time-dependent: early losses correlate with injury and rejection, but late events correlate with donor age and possibly workload.

This article has been cited by other articles:

				P. Schnuelle, U. Gottmann, H. Koppel, P. T. Brinkkoetter, S. Krzossok, J. Weiss, W. Schmitt, B. A. Yard, M. H. M. Schwarzbach, S. Post, et al. Comparison of early renal function parameters for the prediction of 5-year graft survival after kidney transplantation Nephrol. Dial. Transplant., January 1, 2007; 22(1): 235 - 245. [Abstract] [Full Text] [PDF]

				J. S. Neto, A. Nakao, H. Toyokawa, M. A. Nalesnik, A. J. Romanosky, K. Kimizuka, T. Kaizu, N. Hashimoto, O. Azhipa, D. B. Stolz, et al. Low-dose carbon monoxide inhalation prevents development of chronic allograft nephropathy Am J Physiol Renal Physiol, February 1, 2006; 290(2): F324 - F334. [Abstract] [Full Text] [PDF]

				J. W. de Fijter and G. G. Persijn Age, the riddle of renal transplantation Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2307 - 2310. [Full Text] [PDF]

				Y. Avihingsanon, N. Ma, M. Pavlakis, W. J. Chon, M. E. Uknis, A. P. Monaco, C. Ferran, I. Stillman, A. D. Schachter, C. Mottley, et al. On the Intraoperative Molecular Status of Renal Allografts after Vascular Reperfusion and Clinical Outcomes J. Am. Soc. Nephrol., June 1, 2005; 16(6): 1542 - 1548. [Abstract] [Full Text] [PDF]

				G. Stallone, S. Di Paolo, A. Schena, B. Infante, M. Battaglia, P. Ditonno, L. Gesualdo, G. Grandaliano, and F. Paolo Schena Addition of Sirolimus to Cyclosporine Delays the Recovery from Delayed Graft Function but Does not Affect 1-Year Graft Function J. Am. Soc. Nephrol., January 1, 2004; 15(1): 228 - 233. [Abstract] [Full Text] [PDF]

				B. Murphy, J. Yu, Q. Jiao, M. Lin, T. Chitnis, and M. H. Sayegh A Novel Mechanism for the Immunomodulatory Functions of Class II MHC-Derived Peptides J. Am. Soc. Nephrol., April 1, 2003; 14(4): 1053 - 1065. [Abstract] [Full Text] [PDF]

				S. Gourishankar, G. S. Jhangri, S. M. Cockfield, and P. F. Halloran Donor Tissue Characteristics Influence Cadaver Kidney Transplant Function and Graft Survival but Not Rejection J. Am. Soc. Nephrol., February 1, 2003; 14(2): 493 - 499. [Abstract] [Full Text] [PDF]

				M. Pascual, T. Theruvath, T. Kawai, N. Tolkoff-Rubin, and A. B. Cosimi Strategies to Improve Long-Term Outcomes after Renal Transplantation N. Engl. J. Med., February 21, 2002; 346(8): 580 - 590. [Full Text] [PDF]

				P. Schnuelle, J. H. van der Heide, A. Tegzess, C. A. Verburgh, L. C. Paul, F. J. van der Woude, and J. W. de Fijter Open Randomized Trial Comparing Early Withdrawal of either Cyclosporine or Mycophenolate Mofetil in Stable Renal Transplant Recipients Initially Treated with a Triple Drug Regimen J. Am. Soc. Nephrol., February 1, 2002; 13(2): 536 - 543. [Abstract] [Full Text] [PDF]

				J. W. D. FIJTER, M. J. K. MALLAT, I. I. N. DOXIADIS, J. RINGERS, F. R. ROSENDAAL, F. H. J. CLAAS, and L. C. PAUL Increased Immunogenicity and Cause of Graft Loss of Old Donor Kidneys J. Am. Soc. Nephrol., July 1, 2001; 12(7): 1538 - 1546. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673