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Chronologically different impacts of immunologic and non‐immunologic risk factors on renal allograft function
Author(s) -
Kim Myoung Soo,
Kim Dong Kee,
Myoung Sung Min,
Kim Soon Il,
Oh ChangKwon,
Kim Yu Seun,
Lee Jong Hoon,
Kang ShinWook,
Park Kiil
Publication year - 2005
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2005.00414.x
Subject(s) - medicine , quartile , hazard ratio , renal function , creatinine , transplantation , risk factor , proportional hazards model , kidney , histocompatibility , kidney transplantation , analysis of variance , urinary system , urology , immunology , confidence interval , human leukocyte antigen , antigen
Introduction: Upon analysis of the risk factors affecting renal graft survival and function, the time‐dependent effects of each risk factor should be differentiated from their net effects. To evaluate the chronologically different impacts of risk factors on graft renal function, we reviewed 390 recipients who received a kidney from 1‐haplotype‐matched living‐related donors. Materials and methods: Until 5‐yr post‐transplantation (TX), yearly serum creatinine (Scr), 24‐h urinary excretion of protein, and their yearly changes were compared by the episodes of acute rejection within 1 yr, the kidney weight to recipient body weight (KW/BW) ratio, the donor/recipient (D/R) age ratio, and the D/R gender pairing. The Kaplan–Meier method, Cox proportional hazard model, ANOVA, and repeated measures ANOVA were each applied for different purposes. Results: Only the episodes of acute rejection were a significant risk factor affecting graft survival. The episodes of acute rejection, KW/BW ratio, D/R age ratio, and D/R gender pairing consistently and independently had significant influences on Scr. Recipients having the lowest KW/BW ratio (first quartile) or the highest D/R age ratio (fourth quartile) had rapid increments of Scr after 4‐yr post‐TX. After 3‐yr post‐TX, there were significant correlations between the number of non‐immunologic risk factors present and the yearly changes in Scr. Conclusions: Non‐immunologic factors had a detrimental effect on renal graft function, especially after 3‐yr post‐TX. If immunologic risks seem to be similar, size matching, age, and gender pairing should be considered for better long‐term graft function in renal TX recipients.