Renal transplantation remains the treatment of choice kidney transplant survival.
for end-stage renal disease (ESRD) in regards to patient Background. Improvements in long-term kidney graft sursurvival [1]. A recent analysis of the UNOS/OPTN transvival have been recently noted. However, the reasons for this plant database, confirmed that long-term renal graft surwere unclear. This study examined post-transplant renal function within the first year as an independent variable influencing vival measured as graft half-life has improved from 1988 long-term survival. to 1996 [2]. Many risk factors are known to influence long-Methods. The influence of demographic characteristics (age, term graft survival. Among these include: recipient age, sex, race); transplant variables (cadaver versus living donor, race, presence of diabetes, delayed graft function (DGF), cold ischemia time, HLA mismatching, delayed graft function and transplant year), and post-transplant variables (immuno-HLA mismatching, and acute rejection episodes [2-4]. suppressive agents for the prevention of acute rejection, clinical Improvement in half-life was seen even after an adjustacute rejection and post-transplant renal function in the first ment for these risk factors, indicating that additional, year) on graft survival were analyzed for 105,742 adult renal unidentified factors remain. transplants between 1988 and 1998. Renal function in the first year was expressed as serum creatinine at six months and one Renal function within the first year of transplantation year and delta creatinine (change in serum creatinine between also has been reported to an important factor influencing 6 months and 1 year). Graft half-life was used to measure longgraft survival [4-8]. Previous studies that examined renal term survival. function have either been from a single center in the con-Results. During this 11-year period, the one-year serum creatinine values for cadaver recipients steadily improved, from text of acute rejection episode or have utilized discharge 1.82 ฯฎ 0.82 mg/dL in 1988 to 1.67 ฯฎ 0.82 mg/dL in 1998 (P ฯฝ creatinine values [4-8]. Therefore, it has not been possi-0.001), as did the graft half-life. There was a progressive decline ble to separate the effects of renal function and other in graft half-life for each incremental increase of six month, confounding variables such as acute rejection and DGF. METHODS renal function within the first year post-transplantation.